South African Journal of Surgery - Volume 44, Issue 3, 2006
Volume 44, Issue 3, 2006
Source: South African Journal of Surgery 44 (2006)More Less
Extracted from text ... 83 SAJS SURGERY IN SOUTH AFRICA IN CRISIS Surgery in South Africa is in crisis, with the shortage of qualified general surgeons in the state sector having reached critical proportions. The number of vacancies averages 26% nationally - and exceeds 50% in some provinces - and on top the number of newly qualified surgeons annually is only about one-half of the required demand. These are among the main conclusions of the ASSA's long-awaited investigation into the remuneration and working conditions of surgeons in the country, which was prompted by, and confirms, the recent growing concerns for the profession within the ..
Peri-operative anticoagulant therapy - the case for an uninterrupted dose-adjusted warfarin regimen in the high-risk patient : editorialAuthor R.C. FranzSource: South African Journal of Surgery 44, pp 84 –86 (2006)More Less
Extracted from text ... 84 It is generally held that the need for bridging therapy with heparin, when patients on long-term warfarin therapy interrupt their treatment during the peri-operative period, will depend on the patient's risk of thrombo-embolism on the one hand and the risk of bleeding on the other. Although the optimal peri-operative anticoagulant management in patients with a mechanical prosthetic heart valve has not been determined on the basis of well-designed prospective randomised trials, several practical guidelines for clinicians have nevertheless been proposed.1-5 A refined approach is summarised briefly in Table I. From these recommendations it would seem that despite the ..
Source: South African Journal of Surgery 44, pp 88 –94 (2006)More Less
<I>Introduction.</I> General surgery is facing a serious crisis. There has been a significant decline in the number of applicants for registrar posts and an inability to attract and retain general surgical specialists in the state sector. The association of surgeons of South Africa (ASSA) undertook this study to determine the extent and cause of the problem. <BR><I>Methods.</I> The study involved a combination of desk research and structured interviews. In addition, the Health Professions Council of South Africa (HPCSA) database was reviewed and compared with the South African Medical Association (SAMA) and ASSA databases. The medical schools provided information about student numbers and demographics, and the National Department of Health pro vided information about the status of medical practitioner and specialist posts in the state sector. <BR><I>Results.</I> Overall, 26.1% of the specialist posts were vacant. The situation was particularly critical in Mpumalanga and the Eastern Cape, where 84% and 58% of the specialist posts were vacant. Using a predictive model, a conservative estimate of the need for general surgeons was found to be at least 50 per year. Currently the eight medical schools graduate about 25 general surgeons per year. The changing demographics of medical students may be partly responsible for the decline in registrar applicants. <BR><I>Conclusion.</I> The findings from this study have revealed that the shortage of general surgeons in the state sector has reached critical levels.
Source: South African Journal of Surgery 44, pp 96 –107 (2006)More Less
<I>Introduction.</I> Several factors, including comparatively low remuneration, may be responsible for the decline in applicants to general surgery. In this study, the levels of remuneration of general surgeons in the state sector were compared with other professionals in the state sector and general surgeons overseas. <BR><I>Methods.</I> The study involved a combination of desk research and structured interviews. The Paterson system of job evaluation was used to compare general surgeons with other professionals. The levels of remuneration of general surgeons in the state sector were compared with those of other professionals. <BR><I>Results.</I> There was a significant difference in the levels of remuneration between state-employed medical practitioners and other professional positions such as legal professionals, municipal managers and airline pilots. At senior levels (senior specialist) the remuneration was only <U>+</U>55% of that paid to the selected comparator group. There was also a significant differential between the remuneration of state-employed general surgeons and their overseas counterparts. <BR><I>Conclusion.</I> Levels of remuneration of state-employed medical practitioners continue to lag behind other professionals.
Source: South African Journal of Surgery 44, pp 108 –112 (2006)More Less
<I>lntroduction.</I> The association of Surgeons of South Africa (ASSA), because of a concern about the decline in the number of applicants for registrar posts, undertook this study into the various factors that may influence the choice of surgery as career option. <BR><I>Methods.</I> The study involved a combination of desk research and structured interviews with heads of departments, specialists, and registrars in general surgery. <BR><I>Results.</I> The reasons for choosing general surgery as a career included the immediately visible results of a surgeon's efforts and the practical and intellectual challenge of the specialty. General surgery continued to enjoy a high status in society. The greater focus on primary health care has affected facilities at tertiary and secondary institutions. General surgeons worked excessively long hours, which was associated with increased levels of stress and placed severe strains on family life. All respondents felt that their levels of remuneration were 'poor' in relation to other disciplines and professions. <BR><I>Conclusion.</I> In this study we identified various factors that impacted either positively or negatively on the choice of general surgery as a career option.
Source: South African Journal of Surgery 44, pp 114 –118 (2006)More Less
The discovery of HIV and other transfusion-transmissible infections has increased the demand for alternatives to allogeneic blood transfusion. One such alternative is autologous transfusion. This review presents an analysis of autologous transfusion. We conclude that autologous transfusion should form part of a strategy to minimise the risk associated with allogeneic transfusion in Nigeria and other developing countries.
Source: South African Journal of Surgery 44, pp 120 –124 (2006)More Less
<I>Objective.</I> To evaluate the suprahyoid approach to treatment of squamous cell carcinoma of the base of the tongue at Groote Schuur Hospital between 1999 and 2004. <BR><I>Design and method.</I> Retrospective analysis was done of patients with base-of-tongue squamous cell carcinoma treated using the suprahyoid approach. <BR><I>Results.</I> Seventeen patients underwent treatment for base-of-tongue squamous cell carcinoma utilising the suprahyoid approach. Complete medical records were available for 15 of these patients. The most common presenting symptoms were neck mass (40%) and referred otalgia (33%). Alcohol was a risk factor in more patients (64%) than smoking (47%). Adverse pathological findings were present in less than 50% of patients (involved margins 20%, perineural invasion 40%, vascular invasion 33%). Functional outcome in terms of speech intelligibility was excellent and there were minimal swallowing problems, with most patients using compensatory strategies and dietary modification. There were 2 subsequent deaths (13%) as a result of distant metastasis and a second primary. <BR><I>Conclusion.</I> The suprahyoid approach to treatment of base-of-tongue squamous cell carcinoma provides good exposure, local tumour control and excellent functional outcome.