The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa.

Record keeping was very poor and incomplete, and the authors counted anything not recorded as not done, so the files may not show all care that was actually given. The physical clinic setting was not inspected, and equipment and standard operating procedures were assessed only through interviews. Outcome measures were not quantified, and the reason for the 27 amputations was not recorded. Sampling was difficult because contact details were incomplete, some practices withdrew and could not be replaced, large pharmacy groups declined, and public clinic access required in-person permissions. Files were preselected by unit managers, and the study did not compare sectors, so it cannot show which provider type performed better or worse.

Do not conclude that compression therapy caused the 27 amputations. The audit recorded outcomes but did not link them to a specific treatment, and the reason for amputation was not recorded.