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Masters Degrees (Medicine)

Permanent URI for this collectionhttps://hdl.handle.net/10413/8103

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Browsing Masters Degrees (Medicine) by Author "Brown, Susan Lynn."

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    Association between thyroid dysfunction and conventional risk factors in patients with acute coronary syndromes.
    (2019) Ben Hkouma, Mustafa Mansur Mohame.; Brown, Susan Lynn.
    Abstract not available.
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    Deliberate self-harm at RK Khan hospital internal medicine department: the influence of age on the likelihood of admission, triggers, methods used and outcomes.
    (2018) Brown, Susan Lynn.
    A prior suicide attempt is the most important risk factor for complete suicide. For every completed suicide it is estimated that more than 20 suicide attempts are made. From July to December 2016, Deliberate Self-Harm (DSH) was the top admission diagnosis in RK Khan Hospital Internal Medicine Department. We investigated the incidence and demographic patterns of DSH in this department. In addition, the influence of age on the likelihood of admission, triggers, methods used and outcomes was explored. The method used was a retrospect chart review for the period January 2017 to June 2017 of all patients admitted with DSH. Data analysis of continuous variables was summarized as medians for highly skewed variables. Categorical data were summarized using portions and percentages. Proportions were compared using PEARSON’S CHI SQUARE test and FISHER EXACT test as appropriate. A total of 226 patients were included in the study. The incidence of DSH in the study period was 5.12% of total admissions, a reduction from the 9.16% that it represented in the 6 months prior to the study. There was a higher proportion of females admitted compared to the total admissions. The median age was 26 years, with the median age of females being 7 years younger than that of males. There was a higher proportion of adolescent patients admitted with DSH versus the total admissions than other age groups. 18.1% of the study patients reported a previous history of self-harm. Alcohol was involved in 10.6% of cases. The commonest method used was drug overdose, analgesia being the most common agent. The most frequent triggers were that of domestic dispute and romantic/marital relationship problems. There was a low mortality rate of 1.77% and patients stayed on average for 3.05 days. Age and gender were not dependant factors in the outcomes of patients that presented with DSH. Interpretation of age and gender associations with means of DSH, may point to the easy accessibility of drugs playing the decisive role in the choice of method used. The triggers used need to be further explored using qualitative methods for better understanding of their association with age.
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    Warfarin: time in therapeutic range, a single centre study on patients using warfarin for stroke prevention in non-valvular atrial fibrillation and prosthetic heart valves.
    (2016) Sadhabiriss, Dhiren.; Brown, Susan Lynn.
    Background: There are various indications for the use of oral anticoagulants. Two common indications are in patients with atrial fibrillation and prosthetic heart valves. The quality of anticoagulation, determined by the time in therapeutic range, is less often evaluated and has important clinical implications in patient outcomes. Objectives: We sought to identify the indications for anticoagulation and determine the time in therapeutic range and the time out of range at a community-based and district level in patients attending the outpatient department at Mahatma Gandhi Memorial Hospital in KwaZulu Natal, South Africa. Further, we identified factors associated with the quality of anticoagulation and identified prevalence and contributors to thrombo-embolic and haemorrhagic events in anticoagulated patients with atrial fibrillation and prosthetic heart valves. Overview of thesis: Chapter 1 is a review of the literature and identifies the objectives of the study. Chapter 2 describes the study design and methodology. The sample population is described in Chapter 3. Chapter 4 and 5 evaluates the time in therapeutic range and Chapter 6 evaluates for associations thereof. Chapter 7 describes the findings of adverse events and the final chapter summarises the thesis with a general discussion and conclusion. Methods: We conducted a retrospective, descriptive and observational study with chart audits evaluating the anticoagulation control for the preceding one year for each patient. Descriptive statistics included mean and standard deviation for quantitative data and frequencies for categorical data. The variables demonstrated uniformity with linear plots and therefore comparisons of means was conducted by parametric testing. Analysis of variance was conducted for comparisons of variables with post hoc analysis for three groups. Confidence intervals were reported as 95%. Two-tailed p-values were conducted and any p-value less than .05 was considered significant. Results: TTR was poor for patients with atrial fibrillation and prosthetic valves (44.5% and 13.7% respectively). We identified older age, less frequent testing and high target ranges as significant factors associated with poorer outcomes. We demonstrated a high prevalence of adverse events (25.4%). Conclusion: Patients in this setting demonstrated poor quality of anticoagulation and had a high prevalence of adverse events.