Background: Previous studies have found that indications for lumbar punctures (LPs) are managed differently, which raises the question of whether all LPs performed are clinically necessary. This study aimed to determine whether unnecessary (clinically not indicated) LPs were being performed at a district hospital in the Free State, South Africa.Method: This was a retrospective descriptive study. A list from the National Health Laboratory Service (NHLS) was used to identify all patients on whom an LP was performed in the adult emergency department of National District Hospital (NDH) in Bloemfontein, from 1 January 2018 to 30 June 2018. Data were captured on a data sheet and included demographic information, clinical signs and symptoms the patients presented with and the cerebrospinal fluid results.Results: A total of 364 patients fit the inclusion criteria. Of these patients, 97 files (26.6%) could not be found, patient gender and LP results could be retrieved from the NHLS barcodes. After reviewing the presenting symptoms and signs captured on the 267 files, the primary researcher considered 150 (56.4%) of the LPs performed to have been carried out unnecessarily. From the total population of 364 patients, 246 (67.6%) of the LP results were normal. Only 118 (32.4%) of the LPs performed showed some form of central nervous system pathology. Of the 150 LPs assessed to have been unnecessarily performed, 124 (84.0%) were normal.Conclusion: This retrospective review indicates that a high percentage of LPs that were clinically not indicated were performed at NDH during the study period.
CASE REPORT Background. Informing patients about available anaesthesia options allows patients to share in decision-making. Objectives. To determine the preference for general or regional anaesthesia among patients admitted for elective caesarean delivery at a district hospital in Bloemfontein, South Africa, and whether the patients were informed about their anaesthesia options by their doctor. Methods. Consecutive sampling was used. Patients ≥18 years old and who had had a caesarean delivery under general or regional anaesthesia participated in the study. Data were collected using a questionnaire, which was completed during formal interviews with patients. Results. Of the 50 patients interviewed, 30 (60.0%) preferred regional anaesthesia. With regard to the current surgery, 58.0% stated that they were informed of the available anaesthesia options. Conclusion. The majority of the patients in our study preferred regional anaesthesia. Although only 58.0% reported that they received information, many of those valued the doctor's opinion in their choice of anaesthesia.
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