South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde最新文献

{"title":"Towards the quantification of perioperative cardiovascular risk in the African context: A sub-analysis of the South African Surgical Outcomes Study and the African Surgical Outcomes Study.","authors":"C S Alphonsus,&nbsp;H-L Kluyts,&nbsp;V Gobin,&nbsp;A Elkhogia,&nbsp;F D Madzimbamuto,&nbsp;J Tumukunde,&nbsp;A O Omigbodun,&nbsp;C Youssouf,&nbsp;Ryad Mehyaoui,&nbsp;D M Munlemvo,&nbsp;A Basenero,&nbsp;A Antwi-Kusi,&nbsp;D Z Ashebir,&nbsp;A K Ndonga,&nbsp;Z W Ngumi,&nbsp;C M Sani,&nbsp;A L Samateh,&nbsp;T E Madiba,&nbsp;R M Pearse,&nbsp;B M Biccard,&nbsp;On Behalf Of The African Surgical Outcomes Study Asos Investigators","doi":"10.7196/SAMJ.2021.v111i11.15848","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15848","url":null,"abstract":"<p><strong>Background: </strong>The burden of cardiovascular disease in patients requiring non-cardiac surgery in Africa is not known. These patients are at increased risk for postoperative cardiovascular complications.</p><p><strong>Objectives: </strong>In this sub-study, to use data on comorbidities and surgical outcomes from two large observational studies, the South African Surgical Outcomes Study (SASOS) and the African Surgical Outcomes Study (ASOS), to investigate the prevalence of cardiovascular disease in elective surgical patients and the risk of postoperative cardiovascular complications in this population.</p><p><strong>Methods: </strong>SASOS and ASOS were both prospective, observational cohort studies that collected data over 1 week in each participating centre. The primary outcome was in-hospital postoperative complications, which included prespecified and defined cardiovascular complications. We defined the cardiovascular disease burden of patients aged ≥45 years presenting for surgery (main objective), determined the relative risk of developing postoperative cardiovascular complications (secondary objective) and assessed the utility of the Revised Cardiac Risk Index (RCRI) for preoperative cardiovascular risk stratification of elective, non-cardiac surgical patients in Africa (third objective).</p><p><strong>Results: </strong>The primary outcome analysis of 3 045 patients showed that patients with major cardiac complications were significantly older, with a higher prevalence of hypertension, coronary artery disease or congestive cardiac failure, and had undergone major surgery. In-hospital mortality for the cohort was 1.2%.</p><p><strong>Conclusions: </strong>The substantial burden of cardiovascular disease in patients presenting for non-cardiac surgery in Africa is shown in the principal findings of this study. The RCRI has moderate discrimination for major cardiac complications and major adverse cardiac events in African patients undergoing non-cardiac surgery.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1065-1069"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39619995","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":"One-year mortality after hospital admission as an indicator of palliative care need: A retrospective cohort study.","authors":"P Frankenfeld,&nbsp;L Van Niekerk,&nbsp;K Manning,&nbsp;N Tiffin,&nbsp;Peter Raubenheimer","doi":"10.7196/SAMJ.2021.v111i11.15869","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15869","url":null,"abstract":"<p><strong>Background: </strong>Globally there is increasing awareness of the need for end-of-life care and palliative care in hospitalised patients who are in their final year of life. Limited data are available on palliative care requirements in low- and middle-income countries, hindering the design and implementation of effective policies and health services for these patients.</p><p><strong>Objectives: </strong>To determine the proportion of patients who die within 1 year of their date of admission to public hospitals in South Africa (SA), as a proxy for palliative care need in SA.</p><p><strong>Methods: </strong>This was a retrospective cohort study using record linkage of admission and mortality data. The setting was 46 acute-care public hospitals in Western Cape Province, SA.</p><p><strong>Results: </strong>Of 10 761 patients (median (interquartile range (IQR)) age 44 (31 - 60) years) admitted to the 46 hospitals over a 2-week period in March 2012, 1 570 (14.6%) died within 1 year, the majority within the first 3 months. Mortality rose steeply with age. The median (IQR) age of death was 57.5 (45 - 70) years. A greater proportion of patients admitted to medical beds died within 1 year (21.3%) compared with those admitted to surgical beds (7.7%).</p><p><strong>Conclusions: </strong>Despite a median age &lt;60 years at admission, a substantial percentage of patients admitted to public sector hospitals in SA are in the final year of their lives. This finding should be seen in the context of SA's high communicable and non-communicable disease burden and resource-limited public health system, and highlights the need for policy development, planning and implementation of end-of-life and palliative care strategies for hospitals and patients.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1070-1073"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39635591","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":"Blood product utilisation for coronary artery bypass graft surgery at a public and a private hospital in Western Cape Province, South Africa.","authors":"D Wolmarans,&nbsp;A Bird,&nbsp;C Uys,&nbsp;G M Davison","doi":"10.7196/SAMJ.2021.v111i11.15676","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15676","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have documented variation in transfusion practice for coronary artery bypass graft (CABG) surgery, despite the widespread availability of clinical guidelines. Blood management systems seek to streamline utilisation, with key indicators being patient care and outcome as well as reduction of waste and cost.</p><p><strong>Objectives: </strong>To facilitate this view, this study sought to audit blood product utilisation for CABG surgery at a private and a public sector hospital in Western Cape Province, South Africa.</p><p><strong>Methods: </strong>A retrospective audit of 100 consecutive patients undergoing CABG surgery at a private and a public hospital during 2017 was performed. Blood product use was compared between the two hospitals, and the influence of confounding factors such as gender, weight, age, pre- and intraoperative medications, type and complexity of the procedure, and patient comorbidities was analysed.</p><p><strong>Results: </strong>The proportion of patients receiving red cell concentrates (RCCs) at the public hospital was significantly higher than at the private hospital (92% v. 56%; p&lt;0.001), which resulted in significantly higher postoperative haemoglobin concentrations (p&lt;0.001). Although the increased proportion of RCC transfusion observed at the public hospital may have been influenced by decreased body mass (p&lt;0.001), the patient population at the private hospital was older (p&lt;0.05) and had higher rates of ischaemia (p&lt;0.001), increased numbers of grafts (p&lt;0.001) and higher preoperative use of aspirin (p&lt;0.05).</p><p><strong>Conclusions: </strong>This study demonstrated increased use of blood products at the public hospital, despite performing fewer grafts. Although this study had limitations, which included low patient numbers and the inclusion of only two hospitals, we concluded that there is a significant variation in the use of blood products despite the risks associated with blood transfusion. These findings could be used to employ systems that will lead to improved blood usage practices.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1110-1115"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39871094","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":"Glycated haemoglobin (HbA1c) use and glycaemic control in patients living with diabetes mellitus attending public healthcare facilities in KwaZulu-Natal Province, South Africa.","authors":"S Pillay,&nbsp;D Pillay,&nbsp;R Pillay","doi":"10.7196/SAMJ.2021.v111i11.15925","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15925","url":null,"abstract":"<p><strong>Background: </strong>Ideal control of diabetes mellitus (DM) remains a global goal, which has not yet been reached. As part of an integrated public healthcare strategy, data with subsequent analysis of diabetes control achieved in patients living with DM (PLWD) need to be available. Diabetes control data from KwaZulu-Natal (KZN) Province, South Africa, are scarce. Smaller studies conducted in public and private healthcare sectors of KZN have shown suboptimal DM control.</p><p><strong>Objectives: </strong>To identify the percentage of glycated haemoglobin (HbA1c) tests done in KZN public healthcare facilities, and to provide a glimpse into diabetes control being achieved in each KZN district municipality.</p><p><strong>Methods: </strong>Data regarding the number of HbA1c tests performed, number of patients with an HbA1c ≤7% and number of diabetes visits were accessed from the KZN Department of Health Information Systems and analysed.</p><p><strong>Results: </strong>The majority of HbA1c tests were performed in the metro municipality of eThekwini (p&lt;0.001). Approximately two-thirds (64.5%) of PLWD in whom HbA1c tests had been performed, were suboptimally controlled. In 5 of the 11 KZN district municipalities more than two-thirds of PLWD had an HbA1c &gt;7%. Most of the patients in 9 of the 11 district municipalities showed suboptimal control of their DM. The total number of HbA1c tests performed in KZN represents approximately one-tenth of the total number of diabetes treatment visits. This trend was prevalent in all 11 district municipalities, where the incidence of DM was on an upward trajectory.</p><p><strong>Conclusions: </strong>Our study demonstrated that the majority of PLWD visiting public healthcare facilities in KZN have suboptimal glycaemic control. They are at increased risk of developing diabetes-related complications, further burdening the healthcare fiscus of low- to middle-income countries. We also showed that the number of HbA1c tests being performed, in the presence of suboptimal control, was well below par. This finding serves to emphasise the need for strategies to be implemented to increase awareness of HbA1c testing for the monitoring of glycaemic control, and for making point-of-care HbA1c testing readily available in these healthcare facilities.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1060-1064"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39619994","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":"Assessing South African medical interns' experience and confidence in managing obstetric emergencies.","authors":"A C Miller,&nbsp;F J L B Mayanja,&nbsp;J D Porter","doi":"10.7196/SAMJ.2021.v111i11.15897","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15897","url":null,"abstract":"<p><strong>Background: </strong>Medical doctors in South Africa (SA) are required to complete a 2-year internship at training hospitals, including a 4-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts, many of which are at district- and primary-level facilities where supervision is limited. Recent triennial Saving Mothers reports identify district hospitals (DHs) as the second leading site for maternal deaths of all causes, the leading site for maternal deaths secondary to obstetric haemorrhage, and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery.</p><p><strong>Objectives: </strong>To describe the self-perceived readiness of medical interns completing their training to manage obstetric emergencies, based on the Essential Steps in the Management of Obstetric Emergencies modules in the Health Professions Council of South Africa's internship logbook.</p><p><strong>Methods: </strong>This cross-sectional descriptive study assessed medical interns in the last 3 months of their training, using a self-administered online questionnaire. Data collection took place between October and December 2019.</p><p><strong>Results: </strong>Cluster sampling of interns at training facilities throughout SA resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Most interns had experience with and confidence in the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy-related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications for and contraindications to assisted deliveries, and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy-related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section (CS), only 28.6% had performed uterine compression suture for uterine atony at CS. Additionally, there was a statistically significant variation in scores between training hospitals.</p><p><strong>Conclusions: </strong>An incongruity exists between the shortcomings in DH obstetric services, the prioritisation of placement of community service doctors at primary healthcare facilities and DHs, and the self-perceived readiness of medical interns completing their training to manage obstetric emergencies safely. This situation highlights the importance of clinical support for junior doctors at DHs and standardisation of intern training at accredited facilities across SA.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1098-1103"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39635596","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":"Medicolegal cases against obstetricians.","authors":"L R Pistorius,&nbsp;I Bhorat,&nbsp;L Snyman","doi":"10.7196/SAMJ.2021.v111i11.16070","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.16070","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"13439"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39619988","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":"SARS-CoV-2 infection prevalence in healthcare workers and administrative and support staff: The first-wave experience at three academic hospitals in the Tshwane district of Gauteng Province, South Africa.","authors":"N Mdzinwa,&nbsp;M Voigt,&nbsp;C Janse van Rensburg,&nbsp;F Paruk","doi":"10.7196/SAMJ.2021.v111i11.15938","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15938","url":null,"abstract":"<p><strong>Background: </strong>The availability of well and functional healthcare workers (HCWs) and support staff is pivotal to a country's ability to manage the COVID-19 pandemic effectively. While HCWs have been identified as being at increased risk for acquisition of SARS-CoV-2 infection, there is a paucity of data pertaining to South African (SA) HCW-related infection rates. Global and provincial disparities in these numbers necessitate local data in order to mitigate risks.</p><p><strong>Objectives: </strong>To ascertain the overall SARS-CoV-2 infection rates and outcomes among all hospital staff at three hospitals in the Tshwane district of Gauteng Province, SA, and further determine associations with the development of severe COVID-19 disease.</p><p><strong>Methods: </strong>This retrospective audit was conducted across three academic hospitals in the Tshwane district for the period 1 June - 31 August 2020. Deidentified data from occupational health and safety departments at each hospital were used to calculate infection rates. A more detailed analysis at one of the three hospitals included evaluation of demographics, work description, possible source of SARS-CoV-2 exposure (community or hospital), comorbidities and outcomes.</p><p><strong>Results: </strong>The period prevalence of SARS-CoV-2 infections ranged from 6.1% to 15.4% between the three hospitals, with the average period prevalence being 11.1%. The highest incidence of SARS-CoV-2 infections was observed among administrative staff (2.8 cases per 1 000 staff days), followed by nursing staff (2.7 cases per 1 000 staff days). Medical doctors had the lowest incidence of 1.1 cases per 1 000 staff days. SARS-CoV-2 infections were categorised as either possibly community or possibly healthcare facility acquired for 26.6% and 73.4% of the infections, respectively. The administrative group had the highest proportion of possible community-acquired infections (41.8%), while doctors had the lowest (6.1%). The mean age of individuals with mild and severe disease was 41 years and 46.1 years, respectively (p=0.004). The presence of comorbidities was significantly associated with severity of disease (p=0.002).</p><p><strong>Conclusions: </strong>This study highlights that hospital staff, including administrative staff, are clearly at high risk for acquisition of SARS-CoV-2 infection during a surge.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1092-1097"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39635595","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":"Impact of COVID-19 on access to chronic kidney replacement therapy in the public sector of Western Cape Province, South Africa.","authors":"M-Y Chothia,&nbsp;Z Barday,&nbsp;J Nel,&nbsp;M R Davids","doi":"10.7196/SAMJ.2021.v111i11.16113","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.16113","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"13442"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39619985","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":"Going where the data are: Connecting to Trello for daily statistics in the COVID-19 era and beyond.","authors":"M S Moolla,&nbsp;S Lahri,&nbsp;A Parker,&nbsp;N Schrueder","doi":"10.7196/SAMJ.2021.v111i11.16134","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.16134","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1032-1033"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39619987","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":"Hydatid brain cyst: A delayed diagnosis in a rural setting during COVID-19.","authors":"C J Opperman,&nbsp;J M N Enslin,&nbsp;J Nuttall,&nbsp;A J Brink,&nbsp;S P Da Fonseca,&nbsp;H D Tootla","doi":"10.7196/SAMJ.2021.v111i11.16043","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.16043","url":null,"abstract":"<p><p>A previously healthy 10-year-old girl, living in a sheep-farming community in South Africa with exposure to dogs, presented to her local hospital with generalised tonic-clonic seizures. The initial clinical assessment and laboratory work-up were unremarkable. When she presented with further seizures 6 months later, attempts to arrange neuroimaging and specialist assessment were unsuccessful owing to restrictions on routine healthcare services during the SARS-CoV-2 nationwide lockdown. Subsequently, 11 months after her first presentation, she developed focal neurological signs suggestive of raised intracranial pressure. A brain computed tomography scan revealed a left-sided cerebral cyst and imminent tonsillar herniation. An emergency burr-hole procedure was performed to relieve the raised intracranial pressure, followed by definitive neurosurgical excision of cysts. Hydatid protoscolices and hooklets were seen on microscopy of cyst fluid, and treatment with albendazole and praziquantel was initiated. While her infection was treated successfully, long-term sequelae including permanent blindness and hemiparesis could potentially have been prevented with early neuroimaging and surgical intervention.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1050-1054"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39619992","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}