A cross-sectional study to ascertain the prognostic factors and symptoms associated with cryptococcal meningitis cases treated at the East London Hospital complex
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
- Full Text:
- Date Issued: 2012
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
- Full Text:
- Date Issued: 2012
Effective management of machinery in government-operated hospitals
- Authors: Gatang'i, Peter Gatheru
- Date: 2010
- Subjects: Machinery -- Maintenance and repair , Plant maintenance -- Management , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:9664 , http://hdl.handle.net/10948/1237 , Machinery -- Maintenance and repair , Plant maintenance -- Management , Hospitals -- South Africa -- Eastern Cape
- Description: The methodology and the processes that are followed in the maintenance of government-operated district hospitals in the Eastern Cape Province of South Africa are outlined while the strategies that are employed to roll-out the maintenance plan have been investigated. The challenges in managing hospital maintenance are identified so that it can be improved and advice be given on the strategies currently being used. The objectives of the research were to determine the effectiveness of machinery maintenance in government-operated district hospitals. The study has been carried out by investigating 50 district hospitals within the Eastern Cape Province, with the aim of obtaining knowledge of practices in relation to the strategic plans and best practices in the maintenance industry. The following factors identified by the maintenance staff were found to be most important in maintenance management practices; realistic budgets, adherence to occupational health and safety regulations, engagement of qualified and skilled maintenance staff, good record management in relation to the equipment under maintenance, availability of tools and materials and keeping abreast with the latest technologies and trends of machinery advancement. The study also revealed that the majority of the hospitals use a combination of in-house and outsourced personnel during maintenance, the outsourced part being under contract from the National Department of Public Works Repair and Maintenance Plan (RAMP) projects. Service kits and recommended replacement parts for machinery are rarely stocked on the hospital premises while only minor spare parts that include replacement bulbs, electrical fittings, plumbing fittings and paint are readily available. In addition, the maintenance staff members have little or no input in maintenance budgeting, this aspect is controlled by hospital management. For maintenance to be effective, strategic planning that takes into account carefully thought-out maintenance management systems is the first step in the direction of setting out definite tangible objectives and goals. The real challenge lies in the implementation and sustainability of the maintenance management system and the monitoring thereof.
- Full Text:
- Date Issued: 2010
- Authors: Gatang'i, Peter Gatheru
- Date: 2010
- Subjects: Machinery -- Maintenance and repair , Plant maintenance -- Management , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:9664 , http://hdl.handle.net/10948/1237 , Machinery -- Maintenance and repair , Plant maintenance -- Management , Hospitals -- South Africa -- Eastern Cape
- Description: The methodology and the processes that are followed in the maintenance of government-operated district hospitals in the Eastern Cape Province of South Africa are outlined while the strategies that are employed to roll-out the maintenance plan have been investigated. The challenges in managing hospital maintenance are identified so that it can be improved and advice be given on the strategies currently being used. The objectives of the research were to determine the effectiveness of machinery maintenance in government-operated district hospitals. The study has been carried out by investigating 50 district hospitals within the Eastern Cape Province, with the aim of obtaining knowledge of practices in relation to the strategic plans and best practices in the maintenance industry. The following factors identified by the maintenance staff were found to be most important in maintenance management practices; realistic budgets, adherence to occupational health and safety regulations, engagement of qualified and skilled maintenance staff, good record management in relation to the equipment under maintenance, availability of tools and materials and keeping abreast with the latest technologies and trends of machinery advancement. The study also revealed that the majority of the hospitals use a combination of in-house and outsourced personnel during maintenance, the outsourced part being under contract from the National Department of Public Works Repair and Maintenance Plan (RAMP) projects. Service kits and recommended replacement parts for machinery are rarely stocked on the hospital premises while only minor spare parts that include replacement bulbs, electrical fittings, plumbing fittings and paint are readily available. In addition, the maintenance staff members have little or no input in maintenance budgeting, this aspect is controlled by hospital management. For maintenance to be effective, strategic planning that takes into account carefully thought-out maintenance management systems is the first step in the direction of setting out definite tangible objectives and goals. The real challenge lies in the implementation and sustainability of the maintenance management system and the monitoring thereof.
- Full Text:
- Date Issued: 2010
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