Factors affecting patient satisfaction at a plastic surgery outpatient department at a tertiary centre in South Africa.

BACKGROUND: The main purpose of a medical facility is to improve the welfare of patients, and user satisfaction is one of its primary goals. This study aimed to identify variables influencing patient satisfaction at the Plastic Surgery Outpatient Department of Chris Hani Baragwanath Academic Hospital, Gauteng, South Africa. By identifying factors affecting patient satisfaction, the services provided to patients may be improved. METHODS: A questionnaire was compiled focusing on patients over 18 years of age and using a Likert scale to measure factors influencing patients' satisfaction with the services received. Descriptive statistics were applied. RESULTS: A total of 142 participants, 69% of whom were under age 40 and 52.8% were male, were recruited using a systematic sampling technique. In 78% of cases, this was the patient's first visit to the clinic. The results revealed that the patients were not satisfied with the ease of appointment scheduling and waiting times. A high level of satisfaction was reported for both nursing staff and doctors, aside from a lack of clear and prominent display of name badges. Overall satisfaction was at the "satisfied" level, and no participants reported lower than neutral feelings. The CSAT score was 79.5%, which is considered "good" for healthcare. The participant's level of education was significant in multiple items; those with the lowest education reported higher overall satisfaction. A model produced by regression analysis was found to be strongly significant statistically. DISCUSSION: Batho Pele principles in South Africa provide a framework for consulting with service consumers, ascertaining their happiness, and identifying methods to enhance their experience. According to this survey, people are happy with the human part of the services received, although areas such as scheduling appointments and the physical surroundings still need much work. CONCLUSION: These aspects of treatment are occasionally disregarded in a medical organisation with insufficient finances. Developing these areas can help turn patients into devoted patrons of a healthcare facility. An effective strategy to boost customer satisfaction has been suggested to enhance service quality and, especially in South Africa, conform to Batho Pele service standards.

Seasonal Variation of Orofacial Clefts.

BACKGROUND: Orofacial clefts represent the most common craniofacial malformation diagnosed at birth and may be divided into isolated cleft lip (CL), cleft lip and palate (CL/P), or isolated cleft palate (CP). The causes of orofacial clefts have long been understood to be multifactorial; however, research into the genetic and environmental factors underpinning these disorders in African populations is scant. Seasonal variation in the occurrence of orofacial clefts was investigated. Seasonal variation is defined as differences due to periodic, temporal, and external influences, namely the particular time or season of the year. METHODS: The study design is a retrospective record review and sampled patients presenting to the Cleft Clinic at Charlotte Maxeke Johannesburg Academic Hospital during the time period October 2000 to October 2015. Ethical approval was obtained. Information recorded included patient demographics (date of birth and gender), diagnosis and laterality of the cleft. RESULTS: This study includes 512 infants. This study shows seasonal variation in the incidence of orofacial clefts limited to patients with both a CL/P. There was no significant seasonal variation observed in isolated CL or CP and laterality of the cleft. Significant seasonal variation was observed only in those born in winter versus summer, with more children born with a CL/P in winter months. CONCLUSION: Seasonal (or temporal) variation indicates a distinct environmental influence on the formation of orofacial clefts in utero, more specifically in pregnancies with the first trimester during spring. Several reasons have been advanced and include sunlight exposure and vitamin D levels, weight gain, and maternal obesity. More study is required to further elucidate these reasons.

A delayed presentation of ameloblastic fibrosarcoma in an African patient.

A 24-year-old womanpresented with ameloblastic fibrosarcoma arising from ameloblastic fibroma. The delayed presentation accounted for the extensive destruction of the mandible and complete occlusion of her oral cavity. This resulted in an inability to eat and maintain oral hygiene. A multidisciplinary team management approach involved nutritional optimisation, segmental mandibulectomy, reconstruction with a reconstructive plate and a free anterolateral thigh flap to line the the floor of mouth. Functional and aesthetic outcome was acceptable, and the patient is planned for secondary free fibular flap bony reconstruction.

Thyroid Crisis in a Patient With Burn Injury.

Thyroid crisis is an exacerbation of hyperthyroidism that results in severe systemic disturbances and could be fatal. Similarly, severe burn injury also has a hypermetabolic response as part of its presentation. When these two conditions are present concurrently, one must be cognizant that the patient requires urgent optimization of their hyperthyroid status before surgery, and continuous monitoring in an intensive care unit setting. We offer a systematic approach to managing these patients.

Outcomes of laparoscopic sleeve gastrectomy at a bariatric unit in South Africa.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity over the years as a standalone procedure. In 2014, it was the most rapidly growing bariatric procedure. The aim of this study was to describe the outcomes of LSG at a single bariatric unit in Johannesburg, South Africa, using the Bariatric Analysis and Reporting Outcome System (BAROS) standardised scoring. METHODS: A retrospective record review and analysis was carried out using data collected from patients who had LSGs. The information obtained included patient demographics, comorbidities, preoperative weight and height, operative technique, time and complications, postoperative gastrografin swallow results, hospital stay, and weight at 6 months postoperatively. The percentage of excess body mass index (BMI) loss (%EBMIL) was calculated at 6 months, and included in the BAROS questionnaire completed by the patients at the 6-month follow-up visit. Statistical significance was set at p < 0.05. RESULTS: A total of 103 patients were included in the study; of these, 85.4% were female and 14.6% were male. The mean preoperative BMI was 42.1 kg/m2; additionally, 77.7% of the patients in the study had comorbidities prior to the procedure. The mean operative time was 104.3 min, with a mean hospital stay of 2.5 days. No mortalities occurred, and a complication rate of 7.7% was encountered. At the 6-month follow-up, the mean %EBMIL was 65%. When followed up at 6 months, all 103 patients demonstrated no failures according to the BAROS assessment. It was found that 96.1% had good, very good or excellent outcomes. In total, 9.7% of the patients had an excellent outcome. CONCLUSIONS: LSG was shown to produce an adequate %EBMIL loss at 6 months, resulting in a significant improvement in the quality of life (QoL), coupled with good BAROS outcomes. The results of this research are comparable to other studies of LSGs, and the low complication rate supports the use of the procedure and accounts for no observed mortality.

Metastatic trichilemmal carcinoma in a patient with breast cancer.

Trichilemmal carcinoma (TC) is described as a very rare cancer of the skin adnexa.1 2 Ninety per cent of the lesions present on the scalp. Prognostic factors in TC are limited to lymph node status and surgical margins, with no statistical significance observed for age or gender of the patient, size of tumour or locoregional recurrence. We present a 46-year-old black patient who developed TC during treatment for breast cancer. Postoperative histology of the scalp lesion excision confirmed no involved margins. At the three monthly appointment, the patient was reviewed and multiple, new scalp lesions were noted. A CT scan of the head, neck found multiple lesions on the scalp, limited to the soft tissue, not involving the outer table of the skull. There was bilateral invasion of the parotid glands. To the best of our knowledge, no syndromes or associations between breast cancer and adnexal skin tumours exist.