ABSTRACT
Background: Significant mortality and morbidity occur after major lower limb amputation for diabetes-related footcomplications and peripheral arterial disease. Risk factors for atherosclerosis and medical comorbidities are common in amputation for diabetes-related foot complications and are major determinants of outcome. Conversely, the effect of post-hospitalisation circumstances on outcome has not been systematically studied. We hypothesised that poor socioeconomic circumstances after discharge would have an adverse effect on the outcome of major amputation in a developing country.Objectives: To determine the association of the status of post discharge socioeconomic circumstances on the outcome of dysvascular amputation. Methods: This was a prospective cohort study. Patients scheduled for major dysvascular lower limb amputation were recruited. Data were collected regarding the socioeconomic circumstances to which patients would be discharged, such as housing, income and personal care. Patients were followed up at our hospital, at clinics and later telephonically for three years. Mortality and wound morbidity were documented. Association of differences in status of socioeconomic factors and outcomes was analysed statistically.Results: Ninety nine patients were enrolled. Eight patients died in hospital and 91 were discharged. The socioeconomic circumstances of discharged patients were relatively favourable, the majority living in brick houses (92%) with running water (87%). Most patients had a regular income (86%), more than half had state/government grants. The availability of co-habitants, care givers and accessible medical facilities was also favourable. None of the different socioeconomic status levels demonstrated an effect on morbidity or mortality, all associations having a p-value greater than 0.05 (Chi-squared Fisher's exact and Spearman's rank correlation tests).Conclusion: No association between socioeconomic status factors and post-discharge outcome of amputees was demonstrated. This is probably because the dysvascular amputees in this study cohort were living in relatively favourable circumstances
Subject(s)
Amputation, Traumatic/mortality , Diabetes Mellitus/mortality , Patients , South AfricaABSTRACT
Background and objectives: The Western Cape Provincial Medical Advisory Panel (PMAP) was established in 2004 in terms of Section 70(1) of COIDA. A primary function was to improve the efficiency of medical assessment of occupational disease claims. The PMAP was closed by the Compensation Commissioner in 2008. This audit aimed to determine the fate of claims outstanding at the time of closure. Methods: A total of 68 claims outstanding in April 2008 were followed up by telephone; email and/or internet to determine what proportion had progressed or; if accepted; had resulted in a permanent disablement compensation payment. Results: Of the 68 claims; 31 (44) were confirmed as having progressed. Of these; payment of permanent disablement awards could be confirmed in only 15 claims (22). The remaining 56 either showed no progress or no longer had a record in the COIDA system. Those stages of the claims process that had previously been aided by PMAP functioning had deteriorated in efficiency. Conclusions: Overall; the low proportion of outstanding claims finalised and awarded is consistent with inefficiency in claims handling of occupational disease; a finding echoed by recent complaints about general Compensation Fund performance from both healthcare providers and parliamentary investigation
Subject(s)
Health Care Costs , Insurance Claim Review , Occupational Diseases , Workers' CompensationABSTRACT
Background: Literature reports from Western countries suggest an increasing incidence of acute pancreatitis (AP) and changing pattern over the past two decades. The aim of thisstudy was to document the incidence; aetiology and mortality from AP over two decades and to examine any emerging trends.Methods: A retrospective study of all confirmed cases of AP admitted over a 20-year period to thesurgical department was performed. Patients' demographics; year of admission;number of attacks; aetiology; management and outcome were entered on a specialstudy proforma.Results: Altogether 707 attacks of AP (M: F; 5.7: 1) were recorded. The proportion of gallstone APincreased (3.1to 12.7) and that of alcohol-related AP decreased (84to 67.6). Alcohol was themain aetiological factor for AP. Drugs; hyperlipidaemia; human immunodeficiency virus (HIV) andendoscopic pancreatography-related AP increased in the second decade. The in-hospital mortality rateduring the respective periods was 6.5and 3.1.Conclusion: Gallstone AP increased during second decade from more Caucasian admissions and increased gallstones among Blacks. The reduced mortality was attributed to changing trends in the nature and aetiology of AP recorded; heightened awareness of the condition and improved management