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

{"title":"Best interests above belief: Constitutional guidance for life-saving medical decisions involving children.","authors":"S Mahomed","doi":"10.7196/SAMJ.2026.v116i4.5111","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i4.5111","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e5111"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166866","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":"Opportunities to expand delivery of prehospital tranexamic acid to bleeding trauma patients - findings from a prospective multicentre trauma study in the Western Cape Province, South Africa.","authors":"N Abdullah, J Young, W Stassen, C Wylie, H J Lategan, G Oosthuizen, S De Vries, J Verster, EpiC Study Site Collaborators, J M Dixon, N-K Mould-Millman","doi":"10.7196/SAMJ.2026.v116i4.3787","DOIUrl":"10.7196/SAMJ.2026.v116i4.3787","url":null,"abstract":"<p><strong>Background: </strong>Traumatic haemorrhage is a leading cause of preventable injury-related deaths. Tranexamic acid (TXA) has demonstrated a 38% all-cause mortality reduction when administered to severe haemorrhagic shock patients in South Africa (SA). Yet its prehospital utilisation in SA remains limited owing to prehospital provider qualification restrictions, despite the region's high trauma burden. Among the 4% of prehospital providers licensed to administer TXA, prehospital eligibility and TXA administration is poorly reported. This utilisation gap suggests multifactorial barriers beyond the current scope of practice restrictions that impede effective implementation of this evidence-based intervention.</p><p><strong>Objective: </strong>To assess patterns of TXA administration and omission during prehospital emergency care in the Western Cape Province, SA.</p><p><strong>Methods: </strong>This is a secondary analysis from the EpiC prospective multicentre study. The current study examined 4 094 patients at risk of haemorrhage in the Western Cape from August 2021 to December 2024. First, we assessed patient and injury characteristics as well as prehospital and hospital treatments among three prehospital treatment groups: those who received TXA; those who received a lifesaving circulation intervention and no TXA; and those who received neither. Second, a subset of patients was selected for three clinical scenarios: patients with moderate to severe risk of shock; those with severe shock meeting TXA eligibility criteria; and those requiring hospital-based interventions for haemorrhage. Prehospital provider qualifications, clinical interventions and outcomes were assessed using descriptive statistics, and Sankey diagrams were used to visually depict the quantity and flow of prehospital trauma patients stratified by prehospital provider qualification.</p><p><strong>Results: </strong>Only 2.8% (n=116) of all haemorrhage-risk patients received prehospital TXA despite 82% (n=3 325) presenting within the 3-hour window for administration. Among eligible patients with severe risk of shock who were managed by an advanced prehospital provider (n=161), only 19% (n=30) received TXA. Basic and intermediate prehospital providers, who cannot administer TXA under current regulations, managed 67% (n=326) of these patients. These providers frequently delivered other life-saving circulatory interventions (70 - 79%).</p><p><strong>Conclusion: </strong>This study reveals that only a small percentage of eligible trauma patients receive TXA despite its established mortality benefit. The principal barrier identified is the current scope-of-practice restriction preventing basic and intermediate prehospital providers from administering TXA, despite managing two-thirds of eligible patients and possessing the knowledge and skills to deliver TXA. We strongly recommend that the scope of TXA be extended to intermediate prehospital providers in SA.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e3787"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166896","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  new perspective to aid in MMed research report completion: The effort-time trajectory model.","authors":"G Nel, T Ruder, S Kauchali","doi":"10.7196/SAMJ.2026.v116i4.4493","DOIUrl":"10.7196/SAMJ.2026.v116i4.4493","url":null,"abstract":"<p><strong>Background: </strong>Since 2011, the Health Professions Council of South Africa has required all specialist trainees to complete a Master of Medicine (MMed) research report, a requirement intended to strengthen the production of relevant local research. However, evidence shows that this expectation substantially increases trainee workload, contributes to delays in specialist registration and may impede clinical skills development. SA studies report that registrars frequently lack the time and support needed to complete research tasks, with many exceeding the nominal training period. These challenges mirror international experiences where integrating research into busy clinical programmes remains difficult.</p><p><strong>Objective: </strong>To introduce and describe the effort-time trajectory model as an innovative conceptual framework to support MMed trainees in planning and completing their research reports.</p><p><strong>Methods: </strong>We describe the effort-time trajectory model, originally developed by Nel, which complements existing scheduling-based research support models by explicitly incorporating anticipated cognitive effort. Drawing on educational theory, particularly cognitive load theory, the model conceptualises research progression as a dynamic trajectory of both practical and cognitive effort over time.</p><p><strong>Results: </strong>The model highlights predictable peaks - such as protocol development, data analysis and final writing - and lulls, such as routine data collection. Mapping these fluctuations enables early identification of periods where trainees are most vulnerable to overload and where targeted supervisory or institutional support may have the greatest impact.</p><p><strong>Conclusion: </strong>The effort-time trajectory model provides a more holistic lens for supporting MMed research training by accounting for both temporal and cognitive demands. Its application may reduce last-minute workload surges, improve research completion timelines and support more sustainable integration of research within specialist training programmes.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e4493"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166880","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 Life Esidimeni tragedy: A decade later.","authors":"A Dhai","doi":"10.7196/","DOIUrl":"https://doi.org/10.7196/","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e5217"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166693","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 turn for the worse: The impact of deteriorating healthcare spending in South Africa.","authors":"A Bhorat, D Nel, L Cairncross, M Visser","doi":"10.7196/SAMJ.2026.v116i4.3068","DOIUrl":"10.7196/SAMJ.2026.v116i4.3068","url":null,"abstract":"<p><p>The November 2023/2024 national health budget cuts represent the largest reduction in public health expenditure in South Africa's post-apartheid history. This article critically examines the implications of these budget cuts within the context of the country's post-apartheid health system reforms and macroeconomic strategies. Specifically, it documents the historical evolution of fiscal policies and health expenditure across three distinct periods: the 2008 - 2013 period, which witnessed a counter-cyclical fiscal strategy that improved healthcare access and began addressing apartheid-era disparities; the years 2013 - 2023, marked by economic and political instability, culminating in a national debt crisis exacerbated by COVID-19, which eroded health system resilience under fiscal consolidation policies; and the post-November 2023/2024 period, which represents a distinct threat to two decades of progress in health equity and outcomes under further fiscal consolidation measures. The article discusses the impact of these austerity measures on healthcare workers and patient populations and the implementation of the National Health Insurance, while exploring the ethical and legal implications. It concludes by proposing recommendations for system-wide reforms to mitigate the negative effects of these budget cuts and prevent systemic collapse.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 4","pages":"e3068"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166855","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":"Shock index in a rural setting: Can it predict mortality? A retrospective audit in two central hospitals in Limpopo Province, South Africa.","authors":"S N Phaleng, T C Hardcastle","doi":"10.7196/SAMJ.2025.v116i3.3051","DOIUrl":"10.7196/SAMJ.2025.v116i3.3051","url":null,"abstract":"<p><strong>Background: </strong>Shock index is (SI) obtained by dividing heart rate by systolic blood pressure (SBP). Previous studies have shown that SI >0.9 is a predictor of mortality and of a need for blood transfusion in trauma patients.</p><p><strong>Objective: </strong>To determine whether SI can predict mortality and the need for blood transfusion in a rural South African provincial referral hospital cohort.</p><p><strong>Methods: </strong>A retrospective observational cross-sectional study of trauma patients with injury severity score (ISS)>15 in two central hospitals in a rural province was undertaken using data from January 2018 to December 2020. Data collection included demographics, heart rate, blood pressure, SI and modified shock index (MSI) at the time of admission to the emergency department. Univariate and multivariate analyses were performed to identify whether SI predicted death or need for transfusion.</p><p><strong>Results: </strong>The cohort comprised 324 patients. Only emergency department SI and MSI were calculated. In multivariate analysis, χ2 tests showed that SI was a good predictor of mortality (p<0.011) and need for blood transfusion (p<0.001). SI with area under curve 0.673 is a fair predictor of mortality. Student's t-test showed that patients who died had lower mean SI than those who survived, with a mean difference of -2.78 (p=0.006). In multivariate analysis, severe SI predicted the need for blood transfusion (p=0.032).</p><p><strong>Conclusion: </strong>SI is a useful predictor of mortality and the need for blood transfusion in this cohort of referred patients to two central facilities in a rural province. There is likely an impact from resuscitation prior to arrival at the central hospitals.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e3051"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166862","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":"Authors and declarations of interest.","authors":"A Dhai","doi":"10.7196/","DOIUrl":"https://doi.org/10.7196/","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e5065"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166807","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":"Tackling clinical trials disparities in Africa.","authors":"M Kaur","doi":"10.7196/SAMJ.2025.v116i3.4479","DOIUrl":"https://doi.org/10.7196/SAMJ.2025.v116i3.4479","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e4479"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166886","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":"Prevalence and severity of anaemia in persons with haemophilia and von Willebrand disease at Charlotte Maxeke Johannesburg Academic Hospital, South Africa.","authors":"R Monaheng, J N Mahlangu","doi":"10.7196/SAMJ.2025.v116i3.3248","DOIUrl":"10.7196/SAMJ.2025.v116i3.3248","url":null,"abstract":"<p><strong>Background: </strong>Haemophilia and von Willebrand disease (VWD) are inherited bleeding diatheses characterised by spontaneous or traumatic bleeding resulting in varying degrees of anaemia. Early diagnosis, treatment and prevention of anaemia are crucial to improving physical and mental health and enhancing health-related quality of life. The global prevalence of anaemia and its associated risk factors is well established; however, there is a paucity of data on those with inherited bleeding disorders (IBD).</p><p><strong>Objectives: </strong>To describe the prevalence and severity of anaemia in haemophilia and VWD in a quaternary care facility.</p><p><strong>Methods: </strong>Adult patients with haemophilia or VWD of any subtype were identified through hospital record reviews. After excluding those without anaemia, defined as haemoglobin (HB) <13 g/dL for males and <12 g/dL for females, data from patients with anaemia were anonymised, captured, collated and analysed. Quantitative data were summarised with standard statistical tools, and qualitative data were described. The IBD cohort demographics, anaemia severity and prevalence data were compared with those of the controls, who were age- and sex-matched adult patients admitted to the haematology ward.</p><p><strong>Results: </strong>Of 1 100 patients with IBD screened, 77 met the eligibility criteria. These comprised 68 (88.3%) haemophilia patients and 9 (11.7%) patients with VWD. The majority of IBD patients were males, comprising 90.9% (n=70), while females comprised 9.1% (n=7). Of the 886 screened controls, 77 age- and sex-matched patients were selected for comparison. The prevalence of anaemia in the study cohort was 38.96% (n=30). Most patients with anaemia (96.7%, n=29) were male, with only a single female, while in the control group, 85.7% (n=66) were male and 14.3% (n=11) were female. The prevalence of severe anaemia, defined as HB <8 g/dL, was 7% in the IBD group, compared with 22.8% in the control group. In the IBD group, 40% (n=12) of patients had borderline anaemia, compared with the control population with a predominance of life-threatening anaemia (31.2%, n=24). Mild anaemia (HB <11 g/dL) was noted in 37% of the IBD study cohort v. 13% in the control population. Life-threatening anaemia was seen in 13% of the IBD cohort v. 31.2% in the control population. The prevalence of moderate anaemia was 3% in the IBD cohort v. 28.6% in controls. In the IBD cohort, 43% of the anaemic patients had iron deficiency anaemia, and 6.5% of patients in the control group had iron deficiency anaemia.</p><p><strong>Conclusion: </strong>This study indicates the burden of anaemia in the IBD population. Health professionals must be proactive in screening and treating anaemia in these patients. Further research is required to explore additional contributing factors. Optimisation of therapeutic strategies tailored to the unique needs of these patients is vital.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e3248"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166797","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":"Barriers and facilitators to mental health service accessibility among youth in Zambia.","authors":"N Kwibisa","doi":"10.7196/SAMJ.2025.v116i3.3919","DOIUrl":"10.7196/SAMJ.2025.v116i3.3919","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mental health challenges among Zambian youths are an increasing public health concern. Recent studies estimate that ~20% of the Zambian population is affected by mental health disorders, with adolescents showing a sharp rise in reported cases, from 0.7% in 2021 to 1.54% in 2023 (2 914 to 6 825 cases). Despite this growing burden, only 0.1% of government health expenditure is allocated to mental health services, and there is currently no youth-specific policy framework in place. With young people aged 15 - 35 years comprising 36.7% of Zambia's total population, the lack of investment and targeted interventions underscores the urgency of addressing barriers and strengthening facilitators to improve youth access to mental healthcare.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To explore the barriers and facilitators that influence youths' access to mental health services in Zambia, with a focus on understanding the underlying factors that impact service utilisation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature review was conducted, drawing on studies published between 2005 and 2025 from databases including Google Scholar, PubMed and ResearchGate. A total of 20 articles were identified and reviewed, with inclusion based on relevance to youth mental health service accessibility in Zambia. The review did not involve any primary participants; instead, the sample consisted of peer- reviewed studies, national reports and institutional documents. Data were analysed manually using a qualitative thematic approach, where key patterns, recurring themes and emerging categories of barriers and facilitators were identified and synthesised. This approach allowed for an in-depth understanding of the cultural, social and systemic factors that influence youths' access to mental health services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The findings highlight several barriers to accessing mental health services, including stigma, cultural beliefs, inadequate infrastructure and resources, low mental health awareness and gendered norms. The majority of the reviewed literature focused on urban and peri-urban settings, with fewer studies addressing rural contexts. In urban and peri-urban settings, common themes included stigma, limited infrastructure concentrated in tertiary hospitals and gendered expectations that discouraged male youths from seeking care. In rural contexts, the analysis revealed geographical inaccessibility, severe shortages of trained personnel and reliance on traditional or informal sources of support. Across both settings, low awareness of mental health conditions consistently emerged as a barrier. Conversely, facilitators such as school-based mental health programmes, community outreach initiatives, peer support groups and mobile-based interventions were identified as effective strategies to enhance accessibility for youths.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Access to mental health services for Zambian youths is a multiface","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 3","pages":"e3919"},"PeriodicalIF":1.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166836","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}