Browsing by Author "Van der Merwe, Frederick Haynes"

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    Current South African clinical practice in debulking surgery for ovarian cancer
    (BMJ Publishing Group, 2016-10) Billson, Jana; Van der Merwe, Frederick Haynes; Soeters, Robbert; Van der Merwe, Frederick Haynes; Obstetrics and Gynaecology
    Introduction The aim of this study was to assess practice patterns and rationale with regard to debulking surgery for advanced epithelial ovarian carcinoma among South African Gynaecological oncologists. Methods A survey was distributed to all practicing gynecological oncologists in South Africa. It was structured to assess definitions of optimal debulking, procedures used to achieve optimal debulking, and reasons for not performing specific procedures. Respondents were also asked to report on experience and additional surgical training to improve skill in performing ultra-radical debulking surgery. Results Eighty percent of gynecological oncologists completed the survey. Sixty percent of respondents reported that they view optimal debulking as no visible disease, and this was achieved in 63% of surgical cases. The most common barriers to optimal debulking were medical comorbidities (85%), followed by lack of expertise in ultra-radical debulking surgery (55%) and advanced patient age (40%). At operation, the most common disease findings precluding optimal debulking were large volume confluent peritoneal disease and confluent diaphragmatic disease. All of the surgeons perform excision of bulky pelvic and lower paraaortic nodes themselves. Bowel resections are often performed with the help of a colleague, but more than half of the respondents never perform diaphragmatic stripping, resection of liver metastases, distal pancreatic resection, or ablation of peritoneal metastases. Overall, most participants seem to regularly perform debulking procedures in the pelvis but are less comfortable with resection of upper abdominal or peritoneal disease. Most common reasons for not performing procedures were concerns about patient morbidity and concerns regarding benefit. Fifty percent of respondents also reported a lack of personal expertise in performing ultra-radical debulking procedures. Conclusions The progression of South African Gynaecological Oncologist towards more aggressive debulking surgery is following international trends, but many of the surgeons report a lack of experience in ultra-radical debulking surgery, especially in the upper abdomen.
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    The Vaccine and Cervical Cancer Screen (VACCS) project : acceptance of human papillomavirus vaccination in a school-based programme in two provinces of South Africa
    (Health and Medical Publishing Group, 2015) Botha, Matthys H.; Van der Merwe, Frederick Haynes; Snyman, Leon C.; Dreyer, Greta
    Background. The incidence of cervical cancer in South Africa (SA) remains high, and the current screening programme has had limited success. New approaches to prevention and screening tactics are needed. Objectives. To investigate acceptance of school-based human papillomavirus (HPV) vaccination, as well as the information provided, methods of obtaining consent and assent, and completion rates achieved. Methods. Information on cervical cancer and HPV vaccination was provided to 19 primary schools in Western Cape and Gauteng provinces participating in the study. Girls with parental consent and child assent were vaccinated during school hours at their schools. Results. A total of 3 465 girls were invited to receive HPV vaccine, of whom 2 046 provided written parental consent as well as child assent. At least one dose of vaccine was delivered to 2 030 girls (99.2% of the consented cohort), while a total of 1 782 girls received all three doses. Sufficient vaccination was achieved in 91.6% of the vaccinated cohort. Of all invited girls, 56.9% in Gauteng and 50.7% in the Western Cape were sufficiently vaccinated. Conclusion. This implementation project demonstrated that HPV vaccination is practical and safe in SA schools. Political and community acceptance was good, and positive attitudes towards vaccination were encountered. During the study, which mimicked a governmental vaccine roll-out programme, high completion rates were achieved in spite of several challenges encountered.