South African Medical Journal最新文献

{"title":"An analysis of referral patterns of traumatic brain injury at Groote Schuur Hospital Trauma Centre","authors":"N. Parker, T. Navsaria, Mb Chb, M. Lopez, L. Marineau, R. Maine, M. Md, M. T. Md, Fcs D McPherson, P. Navsaria, Fcs Gen Surg","doi":"10.7196/samj.2024.v114i17.1829","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i17.1829","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Traumatic brain injury (TBI) can result in significant morbidity and mortality if not diagnosed in a timely manner. Brain computed tomography (CT) is the diagnostic gold standard but is of limited availability in most South African public hospitals, resulting in transfer of TBI patients to tertiary hospitals.\u0000Objective. To describe the referral patterns and outcomes of patients with TBI referred to Groote Schuur Hospital Trauma Centre. Methods. This was a retrospective audit of all patients admitted to the Trauma Centre who had a brain CT scan for suspected TBI between 1 February 2022 and 31 March 2022. Demographic data (age, sex), mechanism of injury and Glasgow Coma Score were recorded. Referral pathways were determined, and final disposition of patients was recorded.\u0000Results. A total of 522 patients had a brain CT for TBI. Of these, 314 (60.1%) were referred from other hospitals. CT scan was abnormal in 178 (34.1%) patients. Three hundred and two (58.6%) were discharged home within 24 hours. The mean time between referral and CT scan was 13 hours.\u0000Conclusion. More than half of patients referred for a CT scan were discharged from the Trauma Centre within 24 hours of admission, which indicates additional costs and inefficiencies in the health system. These data are useful to guide resource planning and allocation for district hospitals, since less expensive point-of-care modalities now exist to diagnose TBI, and which are useful in indicating the prognosis of patients.\u0000\u0000\u0000\u0000\u0000 \u0000 ","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"72 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed rifampicin and isoniazid resistance by commercial molecular assays","authors":"L. Richards, F. Ismail, J. Nel, S. V. Omar","doi":"10.7196/samj.2024.v114i17.1779","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i17.1779","url":null,"abstract":"\u0000\u0000\u0000\u0000Drug-resistant tuberculosis (TB) has poor outcomes unless resistance is detected early, ideally by commercially available molecular tests. We present a case of occult multidrug-resistant TB where both rifampicin and isoniazid resistance were missed by molecular testing and were only identified by phenotypic testing.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"11 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to be seen and heard: Including children’s and adolescents’ voices in the South African TB response","authors":"C. Goslett, K. Du Preez, G. Hendricks, A. Best","doi":"10.7196/samj.2024.v114i17.2040","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i17.2040","url":null,"abstract":"\u0000\u0000\u0000\u0000Ciara Goslett’s account of childhood tuberculosis (TB) sheds light on the challenges faced by children diagnosed with TB in South Africa (SA). Children are particularly vulnerable to TB infection and to dangerous forms of disseminated TB such as TB meningitis, which can cause death or major lifelong disability. They have distinct challenges with diagnosis, and TB treatment for adults is not necessarily child- friendly. In the absence of a child-friendly formulation, adult tablets are broken into the correct dosage and used to treat children. Crushed and dissolved in water, the pieces are not very palatable for children. There are therefore issues that may be neglected if the voices of children are not included in the TB response in SA. These include delays in the development and accessibility of child-friendly medication, vaccine shortages and a lack of educational support for hospitalised children under school-going age. Some positive progress has been made through the establishment of the paediatric working group in the TB Think Tank, and SA’s contribution to pivotal childhood TB research studies. Additional steps could be the inclusion of children’s feedback in community-led monitoring efforts and engagement between child TB activists and the SA TB Caucus, a collective of parliamentarians.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"257 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptoms of anxiety, depression, and post-traumatic stress disorder 6 weeks and 6 months after ICU: Six out of 10 survivors affected","authors":"E. V. D. Merwe, PhD Int Med, L. Stroud, G. Sharp, PhD N van Vuuren, BTech Mosola, MMed Anaesthesia MB ChB, T. Fodo, Cert Crit Fcp, Care Int, F. Med, Paruk","doi":"10.7196/samj.2024.v114i17.1988","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i17.1988","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Mental health conditions such as depression, anxiety and post-traumatic stress disorder (PTSD) are being increasingly recognised as common adverse outcomes for critical illness survivors. These conditions can have lasting consequences on their wellbeing, ability to return to their pre-illness level of functioning and health-related quality of life. There is a paucity of South African data in terms of the psychological aspects of the post-intensive care unit (ICU) syndrome.\u0000Objective. To identify and characterise patients who suffered from significant symptoms of mental health disease and poor mental health- related quality of life after ICU admission and who may benefit from appropriate referral, further investigation and medical intervention.\u0000Methods. Critically ill patients in a multidisciplinary tertiary ICU were prospectively enrolled upon ICU discharge. Survivors were screened for anxiety, depression and post-traumatic stress syndrome at 6 weeks and 6 months after hospital discharge. The Hospital Anxiety and Depression Score (HADS) and the Impact Of Events Scale – Revised (IES-R) were used as screening tools. The mental component summary score (MCS) of the RAND short form-36 was used to determine the effect of psychological symptoms on health-related quality of life (HRQOL).\u0000Results. The median age of the 107 ICU survivors was 42 years, and half of them were admitted for complications of COVID-19. Six out of every 10 ICU survivors experienced significant symptoms of anxiety, depression and/or PTSD at follow-up. At the 6-month study visit, 4 out of every 10 patients were experiencing significant psychological symptoms. Those affected had a significantly lower mental HRQOL when compared with those who were unaffected. More than half of those affected had co-occurrence of psychological symptoms. Significant symptoms of anxiety were common, with 5 out of every 10 participants experiencing significant symptoms at either, or both, of the study visits. More than 3 out of 10 of affected patients’ symptoms only occurred after the 6-week visit. Associations for significant psychological symptoms comprised female sex, younger age, a diagnosis of trauma and frightening memories of the ICU admission.\u0000Conclusion. The burden of mental health disease in ICU survivors is substantial, affecting their HRQOL. Six out of 10 patients experienced symptoms of anxiety, depression and PTSD, and more than half of those affected experienced co-occurrence of the conditions. A third of those affected developed these symptoms only beyond 6 weeks after hospital discharge. A potentially modifiable association with psychological symptoms was frightening memories of the ICU stay.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"315 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pattern of antibiotic utilisation among intensive care unit patients hospitalised in a Gauteng (South African) provincial tertiary hospital: Comparing findings before and during COVID-19","authors":"MPharm L Spinickum, MPharm Z Booth, MPharm S Leigh","doi":"10.7196/samj.2024.v114i17.1812","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i17.1812","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Various mechanisms may contribute to and direct the progression of antibiotic resistance. A prominent driver associated with antibiotic resistance is inappropriate use or consumption. The sudden emergence of coronavirus disease 2019 (COVID-19 ) changed the conventional practices related to antibiotic utilisation through repurposing the use of antibiotics. Apart from the implementation of antibiotic stewardship programmes, the pressure COVID-19 placed on healthcare systems resulted in poor prescribing and medication review practices, potentially exacerbating antibiotic resistance. Furthermore, the public health system has issues that make it difficult to routinely monitor, quantify antibiotic consumption, and offer evaluation, feedback and intervention, particularly in low- and middle- income countries such as South Africa (SA). Therefore, this study aimed to determine antibiotic utilisation before and during the COVID-19 pandemic in a Gauteng provincial tertiary hospital (GPTH) in SA.\u0000Objective. To determine, examine, and compare antibiotic consumption among intensive care unit (ICU) patients admitted to a GPTH during the pre-COVID-19 period and during the COVID-19 pandemic, in addition to determining the prevalence of the World Health Organisation (WHO) ‘watch’ category antibiotics before and following the emergence of COVID-19 .\u0000Methods. A retrospective cross-sectional data analysis was undertaken of 335 medical files of ICU patients hospitalised in a GPTH between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables (antibiotic selection, dosage, route of administration, frequency, duration of course and indication for which antibiotic was prescribed).\u0000Results. The study found that the most frequently prescribed antibiotics were amoxicillin in combination with clavulanate (pre-pandemic 31.99%; amid-COVID-19 38.43%), followed by ceftriaxone (pre-pandemic 15.44%; amid-COVID-19 14.55%), piperacillin in combination with tazobactam (pre-pandemic 11.40%; amid-COVID-19 8.58%) and azithromycin (pre-pandemic 7.725%; amid-COVID-19 19.78%).\u0000Conclusion. The macrolide and penicillin (in combination with a beta-lactamase inhibitor) classes demonstrated an increase in consumption from the pre-pandemic period moving into the COVID-19 pandemic. This highlights the need for improved antibiotic stewardship programmes and policies to combat inappropriate and unnecessary antibiotic usage.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"38 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Doctors for Life on assisted suicide","authors":"C. A. Joseph","doi":"10.7196/samj.2024.v114i17.2241","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i17.2241","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural-urban disparities and socioeconomic determinants of caesarean delivery rates in Zimbabwe: Evidence from the 2019 National Multiple Indicator Cluster Survey","authors":"G. N. Musuka, G. Murewanhema, MMed Anaesthesia MB ChB, H. Herrera, PhD MPharm, Mbunge, R. Birri-Makota, T. Dzinamarira, PhD D Mph, Cuadros, PhD Chingombe, E. Moyo, A. Mpofu, M. Mapingure, MSc Med","doi":"10.7196/samj.2024.v114i17.1882","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i17.1882","url":null,"abstract":"\u0000\u0000\u0000\u0000Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ2 for a trend of p=0.001 and wealth quintile, and overall χ2 for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Death trends for 2010 - 2022 for members of a large private medical scheme in South Africa","authors":"T. A. Moultrie, PhD H Moultrie, MSc Epidemiology MB BCh, G. Gray, L. Steenkamp","doi":"10.7196/samj.2024.v114i7.1597","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i7.1597","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. In the absence of more recent national data on underlying causes of death in South Africa (SA), we examined mortality trends from 2010 to 2022 among members of a large private medical scheme. This analysis sheds light on the health profile of this specific demographic. Objective. To investigate trends in Discovery Health Medical Scheme (DHMS) members’ death rates and underlying cause of death patterns between 2010 and 2022.\u0000Methods. All-cause deaths were compared across years accounting for demographic changes, by analysing age- and sex-standardised rates using 2019 age and sex population weightings. We used underlying cause-of-death data from death notifications.\u0000Results. The 2019 age- and sex-standardised death rate was lower than the 2010 rate by 10%, with a steady decline experienced between 2010 and 2019. We have seen reduced age- and sex-standardised death rates from HIV/AIDS during this period, and despite the high prevalence, reduced age- and sex-standardised death rates from non-communicable diseases. Malignant neoplasms and cardiovascular disease have been and remained the two leading causes of death for Discovery Health Medical Scheme (DHMS) clients between 2012 and 2022. Age- and sex- standardised death rates, however, reached historic high levels during the first 2 years of the COVID-19 pandemic in SA. In 2020, overall age- and sex-standardised death rates for DHMS members increased to 542 deaths per 100 000 life years, which was higher than pre-pandemic levels. Age- and sex-standardised death rates went on to reach their highest level in the history of the scheme in 2021, at 767 deaths per 100 000 life years. Age- and sex-standardised death rates, however, had returned to near 2019 (pre-pandemic) levels by 2022, at 477 deaths per 100 000 life years. Males experienced a higher increase in age-standardised death rates during 2020 and remained at an increased risk of death in 2022 compared with pre-pandemic levels. When COVID-19 -related deaths are excluded, the age-standardised rates for both females and males in 2022 was lower than observed in the pre-pandemic years. While the low mortality experience could be related to competing causes and mortality displacement, further analysis over a longer period is needed to confirm this.\u0000Conclusion. DHMS experienced the highest level of age- and sex-standardised death rates during 2020 and 2021, the initial 2 years of the COVID-19 pandemic. Most of this increase was explained by COVID-19 deaths.\u0000\u0000\u0000\u0000","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":"23 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assisted suicide: Ethical considerations and the South African debate","authors":"A. Van Eeden","doi":"10.7196/samj.2024.v114i5.2002","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i5.2002","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving access to suicide prevention services through the National Suicide Prevention Framework implementation: The community level evidence-based recommendations","authors":"J. Nyasulu, D. A. Siddiqi, S. Seedat, J. Bantjies, M. Udedi, S. Gondwe, S. Kambale, M. Mkandawire, N. Silungwe, L. A. Hendricks, I. Maposa, J. Vumu, D. Skinner","doi":"10.7196/samj.2024.v114i5.2000","DOIUrl":"https://doi.org/10.7196/samj.2024.v114i5.2000","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":22034,"journal":{"name":"South African Medical Journal","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}