Voorspelling van oorlewing in 'n chirurgiese intensiewesorgeenheid

Doel: Om die voorspellingswaarde van , 14 bestaande voorspellings programme op chirurgiese intensiewesorgpasiente te toets en om n oorlewingsvoorspellingsmodel vir die chirurgiese intensiewesorgeenheid (ClSE) te ontwikkel wat as instrument kan dien om kliniese besluitneming te vergemaklik. Ontwerp: Retrospektiewe en prospektiewe versameling en rekenarisering van kliniese, fisiologiese en biochemiese veranderlikes. Student se t-toets, logistiese regressie, sensitiwiteits- en spesifisiteitsberekening met behulp van tweerigting tabelle. Plek: Chirurgiese  Intensiewesorgeenheid, H. F. Verwoerd-hospitaal, Pretoria. Pasientpopulasie: Retrospektiewe deel van studie: 188 pasiente; prospektiewe deel: 104 pasiente. Bevindingsmaatstawwe: Statisties betekenisvolle verskille tussen die tellings van oorlewendes en nieoorlewendes. Aanvaarbare sensitiwiteit en spesifisiteit van ontwikkelde model. Resultate: AI 14 bestaande voorspellingsprogramme beskik oor die vennoe om te onderskei tussen die opnamedagtellings van oorlewendes en nie-oorlewendes en het, by implikasie, dus prognostiese geldigheid. Die statistiese betekenisvolheid geassosieer met die onderskeie programme het gewissel van P < 0.01 tot P < 0.0001. 'n Reeks van opeenvolgende oorlewingsvoorspel1ingsmodelle, ontwikkel deur logistiese regressie-analise op die bes passende voorspellingsprogramme, het uiteindelik gelei tot die ontwikkeling van 'n model met 'n sensitiwiteit van 93% en 'n spesifisiteit van 66%. Gevolgtrekking: Verskeie bestaande voorspellingsprogramme kan bydra tot kliniese besluitneming. Voorspellingsmodelle hieruit ontwikkel moet voor implementering herhaaldelik op opeenvolgende groepe van die teikenpopulasie getoets word. Beide die programme en die modelle behoort as bykomstige prognostiese ondersteuningsfaktore gebruik te word eerder as absolute aanduidings van uitkoms.S Afr Med J 1996: 86: 1417 -142

Non-Stationary Forward Flux Sampling

We present a new method, Non-Stationary Forward Flux Sampling, that allows efficient simulation of rare events in both stationary and non-stationary stochastic systems. The method uses stochastic branching and pruning to achieve uniform sampling of trajectories in phase space and time, leading to accurate estimates for time-dependent switching propensities and time-dependent phase space probability densities. The method is suitable for equilibrium or non-equilibrium systems, in or out of stationary state, including non-Markovian or externally driven systems. We demonstrate the validity of the technique by applying it to a one-dimensional barrier crossing problem that can be solved exactly, and show its usefulness by applying it to the time-dependent switching of a genetic toggle switch.Comment: 18 pages, 10 figure

Prevalence of chronic pain in patients attending primary healthcare facilities in south-west Tshwane

OBJECTIVES: Despite the significant biopsychosocial impact of chronic pain on the health and quality of life of an individual, as well as on healthcare utilisation, no published data are available on the prevalence of chronic pain in the South African primary healthcare context. The aim of this study was to investigate the prevalence and intensity of chronic pain in patients attending primary healthcare facilities in south-west Tshwane. DESIGN SETTING: A prospective, cross-sectional study was carried out in four primary healthcare clinics, situated in south-west Tshwane. SUBJECTS: The study was conducted on 1 066 adult patients, aged 18 years or older, over a nine-week period between October and December 2010. OUTCOME MEASURES: The prevalence and intensity of chronic pain was determined. RESULTS: Chronic pain prevalence was 41%. The confidence interval (CI) was 37.2-45.6. Chronic pain was most frequently experienced as lower back pain [prevalence 30.83% (CI: 19.56-42.09)] and joint pains [prevalence 23.48% (CI: 7.58-39.38)]. Chronic pain was significantly more prevalent with advancing age (p-value = 0.0014), in women than in men (p-value = 0.019), and in widowed and divorced patients, than in married and single patients (p-value = 0.0062). Patients with chronic pain reported their pain intensity over the previous month as maximum pain intensity (mean: 7.69 ± 0.99), minimum pain intensity (mean 2.54 ± 0.89), and average pain intensity (mean 4.57 ± 0.62). CONCLUSION: Chronic pain was highly prevalent in patients who attended primary healthcare facilities in south-west Tshwane. The intensity of pain was high in a significant proportion of patients.www.safpj.co.zaam201

The impact of chronic pain on the quality of life of patients attending primary healthcare clinics

OBJECTIVES: The objective was to study the nature and magnitude of the impact of pain on the quality of life of patients with chronic pain. DESIGN: This was a descriptive, cross-sectional quantitative study. SETTING AND SUBJECTS: One thousand and sixty-six adult patients were screened between October and December 2010 in four primary healthcare clinics in south-west Tshwane. OUTCOME MEASURES: Patients reporting persistent pain for six months or longer were considered to be chronic pain patients (437, 41%), and were interviewed with regard to the impact of chronic pain on their quality of life using the Wisconsin Brief Pain Questionnaire. RESULTS: Four hundred and nineteen patients (95.9%, 95% confidence interval (CI): 93.6-97.6) of chronic pain patients reported that chronic pain impacted on their quality of life and functioning. Sixty-eight per cent of patients (95% CI: 63.3- 72.4) reported being severely adversely affected by chronic pain. Pain had a severe impact on sleep quality in 39.2% patients, walking ability (37.4%), routine housework (33.8%), mood (20.1%), interpersonal relationships (15.3%) and enjoyment of life (16.3%). The more intense the experience of severe pain was, the greater the impact of chronic pain on everyday life (p-value < 0.001). Equally, patients with better pain relief enjoyed a better quality of life (p-value < 0.001). CONCLUSION: A substantial proportion of patients attending primary healthcare clinics experience chronic pain which impacts on their lives in multiple and significant ways.http://www.sajaa.co.za/index.php/sajaaam201

Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane

BACKGROUND : The management of patients presenting with chronic tension-type headache (CTTH) can be challenging for primary health care practitioners. As with most chronic pain disorders, a multimodal management approach is frequently required. It has been postulated that myofascial pain syndrome (MPS) and its hallmark myofascial trigger points (MTrPs) found in specific muscle tissues may play a role in the chronic pain experienced by patients with CTTH. Little is known about the prevalence of MTrPs in patients with CTTH, in primary health care settings on the African continent. This study therefore aimed to investigate the prevalence of active MTrP’s in specific head and neck muscles/muscle groups in patients with CTTH. METHODS : A prospective, cross-sectional and descriptive study was done in two primary health care facilities situated in Tshwane, South Africa. The sample included 97 adult patients with CTTH. Five head and neck muscles/muscle groups were examined bilaterally for active MTrPs. Outcome measures were the prevalence and distribution of active MTrPs in these patients. RESULTS : Active MTrPs were found in 95.9% of the patients, the majority (74.2%) having four or more active MTrPs. The temporalis muscles and suboccipital muscle group exhibited the highest number of active MTrPs (prevalence 87.6% and 80.4% respectively). CONCLUSION : Our study suggests a strong association between MPS and CTTH in patients, presenting in the primary health care setting. This indicates the importance of a musculoskeletal assessment of neck and pericranial muscles in patients with CTTH. This can assist in determining the most appropriate treatment strategy in these patients.http://www.safpj.co.za/index.php/safpjhttp://www.tandfonline.com/oemdam2017Family Medicin

e3 service: A Critical Reflection and Future Research

Commercial services are of utmost importance for the economy. Due to the widespread use of information and communication technologies, many of these services may be delivered online by means of service value networks. To automate this delivery, however, issues such as composition, integration, and operationalization need to be addressed. In this paper, the authors share their long-term vision on composition of service value networks and describe relationships with fields such as cloud computing and enterprise computing. As a demonstration of the state of the art, capabilities and limitations of e 3 service are described and research challenges are defined

Assessment of bone ingrowth potential of biomimetic hydroxyapatite and brushite coated porous E-beam structures

The bone ingrowth potential of biomimetic hydroxyapatite and brushite coatings applied on porous E-beam structure was examined in goats and compared to a similar uncoated porous structure and a conventional titanium plasma spray coating. Specimens were implanted in the iliac crest of goats for a period of 3 (4 goats) or 15 weeks (8 goats). Mechanical implant fixation generated by bone ingrowth was analyzed by a push out test. Histomorphometry was performed to assess the bone ingrowth depth and bone implant contact. The uncoated and hydroxyapatite-coated cubic structure had significantly higher mechanical strength at the interface compared to the Ti plasma spray coating at 15 weeks of implantation. Bone ingrowth depth was significantly larger for the hydroxyapatite- and brushite-coated structures compared to the uncoated structure. In conclusion, the porous E-beam surface structure showed higher bone ingrowth potential compared to a conventional implant surface after 15 weeks of implantation. Addition of a calcium phosphate coating to the E-beam structure enhanced bone ingrowth significantly. Furthermore, the calcium phosphate coating appears to work as an accelerator for bone ingrowth