Southern African Journal of Critical Care最新文献

{"title":"Groote Schuur Hospital neurosurgical intensive care unit: A 2-year review of admission characteristics","authors":"S. Rashid, I. Joubert, P. Semple","doi":"10.7196/sajcc.2023.v39i3.1217","DOIUrl":"https://doi.org/10.7196/sajcc.2023.v39i3.1217","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. At Groote Schuur Hospital (GSH), the neurosurgical intensive care unit (NsICU) is a 6-bed unit headed by a specialist neurosurgeon with extensive experience in neurocritical care, working in close collaboration with intensivists from the Division of Critical Care. There is currently no detailed analysis of the demographics, diagnosis and management of patients admitted to the NsICU at GSH.\u0000Objectives. To provide a detailed descriptive analysis of the demographics, diagnosis and management of patients admitted to the NsICU at GSH from 1 January 2020 to 31 December 2021.\u0000Methods. A retrospective descriptive analysis was done of patients who received treatment in the NsICU from 1 January 2020 to 31 December 2021.\u0000Results. A total of 685 patients were admitted to the unit over a 2-year period, with a male preponderance (68.2%). The average age was 42.5 (standard deviation (SD) 17.2) years. The most common neurosurgical diagnoses were traumatic brain injuries (39.6%), brain tumours (22.6%) and aneurysmal subarachnoid haemorrhages (9.9%). Emergency admissions comprised 76.6% of the total and 86.7% of patients were admitted postoperatively. Three hundred and seventy-two patients (54.3%) required mechanical ventilation, 132 (19.3%) required both an intracranial pressure (ICP) monitor and brain tissue oxygenation monitor, 86 (12.5%) needed placement of an external ventricular drain, 50 (7.3%) needed placement of a tracheostomy tube and 16 (2.3%) needed placement of an ICP monitor only. The average duration of stay was 5.5 (1.3) days and NsICU mortality over 2 years was 11.1%.\u0000Conclusion. The NsICU at GSH manages predominantly male trauma patients and a significant number of admitted patients require specialised invasive intracranial monitoring.\u0000\u0000\u0000\u0000","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"33 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139003538","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":"Outcomes of traumatic brain injury patients in an adult intensive care unit of a South African regional hospital, without on-site neurosurgical service: A retrospective quantitative study on the neurological improvement at discharge","authors":"A. Sallie, R. Wise","doi":"10.7196/sajcc.2023.v39i3.1286","DOIUrl":"https://doi.org/10.7196/sajcc.2023.v39i3.1286","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Traumatic brain injury (TBI) is a major cause of mortality and disability. The South African (SA) province of Kwazulu-Natal faces challenges in providing appropriate care for TBI patients owing to limited resources and delayed access to healthcare services. We aimed to assess the outcomes of patients with TBI who were treated at a hospital without a neurosurgical unit (NSU).\u0000Objectives. The primary objective was to compare the Glasgow Coma Scale (GCS) scores at admission and discharge from the intensive care unit (ICU) for patients with TBI receiving neuroprotection. Secondary objectives included analysing demographics and identifying predictive factors associated with GCS score improvement.\u0000Methods. This retrospective study analysed data from the already established ICU Integrated Critical Care Electronic Database. Data on patient demographics, mechanisms of injury and GCS scores were collected and analysed.\u0000Results. The analysis included 95 TBI patients, most of whom were young males. Interpersonal violence and transport-related trauma were the main causes of injury among patients. Approximately 63% of patients had a GCS score improvement >1 upon discharge from the ICU. Patients who received >12 hours of neuroprotection in the emergency department had significantly lower rates of improvement.\u0000Conclusion. Sixty-three percent of TBI patients had improved GCS scores by >1 on discharge from the ICU, but outcomes varied. Delayed ICU admission from the emergency department of >12 hours might contribute to worse outcomes. Timely neuroprotection, improved access to neurosurgical care and better understanding of the factors affecting outcomes are needed.\u0000\u0000\u0000\u0000","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"75 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138976325","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":"Deep medicine ...  Navigating the intersection of technology, cognition and ethics in the digital age of medicine","authors":"D. Gopalan, M. Pienaar, S. Brokensha","doi":"10.7196/sajcc.2023.v39i3.1520","DOIUrl":"https://doi.org/10.7196/sajcc.2023.v39i3.1520","url":null,"abstract":"\u0000\u0000\u0000\u0000The digital expansion in medicine and healthcare has been immense and extremely valuable. The biggest concern in the face of this inevitable growth is how we manage to keep contact with our patients and preserve the human touch so essential in healing. Digital healthcare should not be about technology replacing clinicians. Instead, it should be about augmenting and supplementing healthcare providers to improve the ways in which we deliver personalised healthcare. It is vital that we focus on how we can revitalise the patient-clinician relationship in this digital age.\u0000\u0000\u0000\u0000","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"26 S18","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139004019","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":"Core competencies in critical care for general medical practitioners in South Africa: A Delphi study","authors":"S. D. Maasdorp, F. Paruk, K. De Vasconcellos, C. Grion, I. Joubert, G. Joynt, N. Kalafatis, S. E. Lapinsky, J. Lipman, M. L. N. G. Malbrain, B. Mrara, G. Richards, M. Spruyt, E. Van der Merwe, J-L Vincent, L. J. Van der Merwe","doi":"10.7196/sajcc.2023.v39i3.1261","DOIUrl":"https://doi.org/10.7196/sajcc.2023.v39i3.1261","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training.Objectives. To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management.\u0000Methods. A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process.\u0000Results. A final list of 153 core competencies in critical care was identified.\u0000Conclusion. The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA.\u0000\u0000\u0000\u0000","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"17 11","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139004870","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":"Patient perceptions of ICU physiotherapy: ‘Your body needs to go somewhere to be recharged ... ’","authors":"F. Karachi, M. B. Van Nes, S. Hanekom, R. Gosselink","doi":"10.7196/sajcc.2023.v39i3.1092","DOIUrl":"https://doi.org/10.7196/sajcc.2023.v39i3.1092","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Patient satisfaction is an essential concept to consider for the improvement of quality care in healthcare centres and hospitals and has been linked to increased patient compliance with treatment plans, better patient safety and improved clinical outcomes.\u0000Objective. As part of a before-and-after clinical trial aimed to investigate the implementation of an evidence-based and -validated physiotherapy protocol within a surgical intensive care unit (ICU), we decided to include the patient perception of physiotherapy received in the intervention unit.\u0000Method. A nested, exploratory, descriptive, qualitative study design was adopted. Purposively selected adult patients discharged from ICU during the implementation phase of the trial were interviewed.\u0000Results. Eighteen patients (10 male) with a median age of 44 years and median ICU length of stay (LOS) of six days were included. Three themes and nine categories emerged: (i) linking therapy to clinical outcome (patient expectations and understanding; physiotherapy activities and the implication of mobilisation; physiotherapy benefits and progression); (ii) the importance of developing a trusting relationship (physiotherapy value; safety; continuity of care); and (iii) communication (satisfaction; interactions and patient perception and experience of physiotherapy).\u0000Conclusion. While confirming barriers to early mobility, patients perceived participation in mobility activities as a marked jolt in their journey to recovery following a critical incident. Effective communication and preservation of trust between physiotherapist and patient are essential for understanding expectations and can facilitate improved outcomes. Clinicians can use the information when managing critically ill patients. Including patient-reported outcomes to measure physiotherapy interventions used in the ICU is feasible and can inform the development of such outcomes.\u0000\u0000\u0000\u0000\u0000 \u0000 ","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"88 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005569","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 utility of brain natriuretic peptide as a prognosticating marker in critical care patients","authors":"A. Naidoo, K. De Vasconcellos","doi":"10.7196/sajcc.2023.v39i3.1218","DOIUrl":"https://doi.org/10.7196/sajcc.2023.v39i3.1218","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Brain natriuretic peptide (BNP) is an established biomarker of morbidity and mortality in cardiac failure. Data also suggest potential prognostic utility in non-heart failure cohorts. The utility of BNP in predicting intensive care unit (ICU) outcomes has not been well evaluated in a mixed critical care population in the South African (SA) context.\u0000Objective. To evaluate the ability of BNP to predict ICU mortality in a heterogeneous critical care population in SA.\u0000Methods. This was a retrospective observational study of 100 patients admitted to a multidisciplinary, closed, intensivist-run ICU in a tertiary academic hospital serving KwaZulu-Natal Province (1 January 2020 - 31 July 2022). Initial BNP was evaluated as a predictor of ICU mortality using univariate and multivariable analyses.\u0000Results. There was a statistically significant difference in BNP between survivors and non-survivors in the cohort of patients without heart failure. The median initial BNP in the non-heart failure cohort was 411 (interquartile range (IQR) 116 - 848) ng/L in non-survivors, and 150 (44 - 356) ng/L in survivors (p=0.028). The optimal cut-off for BNP was determined as 366 ng/L. A BNP ≥366 ng/L was an independent predictor of ICU outcome.\u0000Conclusion. This study highlights the potential utility of BNP as a predictor of ICU mortality in a heterogeneous ICU population, with the greatest utility in patients without heart failure. Further studies are required to confirm this finding.\u0000\u0000\u0000\u0000","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"79 11","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005731","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":"Quantifying the burden of the post-ICU syndrome in South Africa: A scoping review of evidence from the public health sector","authors":"E. van der Merwe, F. Paruk","doi":"10.7196/SAJCC.2022.v38i2.527","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i2.527","url":null,"abstract":"Background The post-ICU syndrome (PICS) comprises unexpected impairments in physical, cognitive, and mental health after intensive care unit (ICU) discharge, and is associated with a diminished health-related quality of life (HRQOL). A Cochrane review recommended more research in this field from low- and middle-income countries. Objectives This review aims to examine the extent and nature of publications in the field of PICS in the South African (SA) public health sector. Findings of available local research are contextualised through comparison with international data. Methods A comprehensive literature search strategy was employed. Inclusion criteria comprised publications enrolling adult patients following admission to SA public hospital ICUs, with the aim to study the main elements of PICS (ICU-acquired neuromuscular weakness, neurocognitive impairment, psychopathology and HRQOL). Results Three studies investigated physical impairment, 1 study psychopathology, and 2 studies HRQOL. Recommended assessment tools were utilised. High rates of attrition were reported. Neuromuscular weakness in shorter-stay patients had recovered at 3 months. Patients who were ventilated for ≥5 days were more likely to be impaired at 6 months. The study on psychopathology reported high morbidity. The HRQOL of survivors was diminished, particularly in patients ventilated for ≥5 days. Conclusion This review found a paucity of literature evaluating PICS in the SA public health sector. The findings mirror those from international studies. Knowledge gaps pertaining to PICS in medical, surgical and HIV-positive patients in SA are evident. No publications on neurocognitive impairment or the co-occurrence of PICS elements were identified. There is considerable scope for further research in this field in SA. Contributions of the study This review identified the available publications investigating the post ICU syndrome (PICS) in the South African public healthcare setting. A small number of ground-breaking studies were found. Knowledge gaps in this field were identified.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46972927","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":"A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar","authors":"M. Galatsch, H. Lang, C. Noa, H. Raveloharimino, A. Robinson, N. Rabesandratana, L. Magera, R. Weigel, D. Köcher-Andrianarimanana","doi":"10.7196/SAJCC.2022.v38i2.535","DOIUrl":"https://doi.org/10.7196/SAJCC.2022.v38i2.535","url":null,"abstract":"Background Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted in December 2019 at the University Hospital Mahajanga. Objectives This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved their learning objectives. Methods In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities. Results Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multi-disciplinary efforts are needed to advance ETAT+ implementation in Madagascar. Conclusion Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to contexts in Madagascar. Contributions of the study This study aims to evaluate an updated Malagasy version of the Emergency Triage Assessment and Treatment Plus (ETAT+). The training met the participants’ needs and was adapted to the clinical realities in Madagascar relating to transmitted knowledge, skills and competencies.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49343550","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 impact of the Fundamental Critical Course on knowledge acquisition in Rwanda","authors":"D. Hopkinson, K. Akuamoah-Boateng, P. Banguti, J. P. Mvukiyehe, C. Zerfoss, T. Eng, E. Tuyishime, K. Hertel, D. Starling, A. Bethea, B. Moses, A. Syed","doi":"10.7196/sajcc.2022.v38i1.491","DOIUrl":"https://doi.org/10.7196/sajcc.2022.v38i1.491","url":null,"abstract":"Background Emerging critical care systems have gained little attention in low- and middle-income countries. In sub-Saharan Africa, only 4% of the healthcare workforce is trained in critical care, and mortality rates are unacceptably high in this patient population. Objectives We sought to retrospectively describe the knowledge acquisition and confidence improvement of practitioners who attend the Fundamental Critical Care Support (FCCS) course in Rwanda. Methods We conducted a retrospective study in which we assessed survey data and multiple-choice question data that were collected before and after course delivery. The purpose of these assessments at the time of delivery was to evaluate participants’ perception and acquisition of critical care knowledge. Results Thirty-six interprofessional clinicians completed the training. Performance on the multiple-choice questions improved overall after the course (mean score pre-course of 56.5% to mean score post-course of 65.8%, p-value <0.001) and improved in all content areas with the exception of diagnosis and management of acute coronary syndrome and acute respiratory failure/mechanical ventilation. Both physicians and nurses improved their scores significantly (68.9% to 75.6%, p-value = 0.031 and 52.0% to 63.5%, p-value <0.001, respectively). Self-reported confidence in level of knowledge also increased in all areas. Survey respondents indicated on open-answer questions that they would like the course offerings at least annually, and that further dissemination of the course in Rwanda was warranted. Conclusion Deploying the established FCCS course improved Rwandan healthcare provider knowledge and confidence across most critical care content areas. Therefore, this course represents a good first step in bridging the gaps noted in emerging critical care systems. Contributions of the study Critical care education in sub-Saharan Africa is limited and few staff have formal training. The aim of the study was to determine whether a focused course delivered in Rwanda on critical care management improved knowledge in key areas. Our retrospective study on results from a multiple choice question test and survey indicate that short courses may improve knowledge of critical care management.","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"38 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42081231","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":"Mortality risk prediction models: Methods of assessing discrimination and calibration and what they mean.","authors":"L J Solomon","doi":"10.7196/SAJCC.2022.v38i1.548","DOIUrl":"10.7196/SAJCC.2022.v38i1.548","url":null,"abstract":"","PeriodicalId":42653,"journal":{"name":"Southern African Journal of Critical Care","volume":"38 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71268460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}