Practising anaesthesia as a community service doctor: a survey-based assessment

Background: Anaesthesia-related maternal mortality remains unacceptably high, especially in district hospitals. Community service doctors (CSDs) play an important role in the provision of anaesthesia in these hospitals. The purpose of this study was to understand the experience of doctors providing anaesthesia during community service. Identifying deficiencies in the performance of anaesthesia by CSDs can lead to remedial actions.Methods: A prospective, questionnaire-based study was done of doctors who had done their anaesthesia rotation during their internship in Pietermaritzburg, between 2008 and 2010. Quantitative data were collected regarding their performance of anaesthesia during community service. The data included details concerning the provision of anaesthesia, supervision and training, and whether CSDs felt adequately prepared to perform anaesthesia during community service. Qualitative data were also collected, which will be reported in another article.Results: The study response rate was 72.9%. Roughly half of the respondents performed anaesthesia during community service, of which two-thirds did more than 50 cases. Obstetric anaesthesia was the most common procedure performed. CSDs worked largely unsupervised, 63% had very little supervision and 62% received no further training in anaesthesia during community service. CSDs felt adequately prepared to administer obstetric anaesthesia, but less well prepared to perform general anaesthesia for appendicectomies and ectopic pregnancies.Discussion: CSDs perform a large proportion of the anaesthesia in rural hospitals, where they work largely unsupervised. Furthermore, CSDs feel less well prepared to perform general anaesthesia than spinal anaesthesia. To meet the needs of patients in these areas, intern training needs to be aimed at improving anaesthesia delivery in rural hospitals and guidelines need to be established regarding the performance of anaesthesia by CSDs.Conclusion: The study showed that CSDs play an important role in provision of anaesthesia services, especially in rural areas. However, they work largely unsupervised and receive little further training or support. A large proportion do not feel comfortable in administering general anaesthesia. Intern training should be adjusted to meet the needs of CSDs.Keywords: Intern training in anaesthesia, community service doctors experienc

Creating the perfect intern anaesthesia rotation: a survey using feedback from past interns

Background: Community service doctors (CSDs) are often expected to administer anaesthesia after minimal training and with very little support, especially in rural hospitals. This leads to unnecessary stress on these junior doctors and may lead to poor anaesthesia outcomes.Objectives: The aim of this study was to understand the experiences of CSDs administering anaesthesia. This feedback will be used to improve the current intern training programme for anaesthesia and to structure the rotation according to their needs.Methods: A questionnaire was sent to Pietermaritzburg (PMB) interns who completed their anaesthesia intern rotation between 2008 and 2010. Two data sets were collected: quantitative data (this will be reported on in another paper) and qualitative data. The qualitative data included five open-ended questions about the intern rotation in anaesthesia.Results: Between 2008 and 2010, 298 interns completed an anaesthetic rotation. The survey was sent to 259 doctors of whom 189 responded (73%). The first three questions were about the structure of the intern rotation in anaesthesia. The responses were analysed together. The following feedback was common: more autonomy, longer duration of the anaesthesia rotation and more practical exposure during the rotation. Questions 4 and 5 were about the impact of internship and community service on future career choice. Community service had a greater impact on career choice than internship.Conclusion: Intern training in anaesthesia is essential to create confident CSDs. Feedback from previous interns should be used to improve intern training programmes.Keywords: anaesthesia education, intern training, obstetric anaesthesia training, rural health car

National priorities for perioperative research in South Africa

BACKGROUND. Perioperative research is currently unco-ordinated in South Africa (SA), with no clear research agenda. OBJECTIVE. To determine the top ten national research priorities for perioperative research in SA. METHODS. A Delphi technique was used to establish consensus on the top ten research priorities. RESULTS. The top ten research priorities were as follows: (i) establishment of a national database of (a) critical care outcomes, and (b) critical care resources; (ii) a randomised controlled trial of preoperative B-type natriuretic peptide-guided medical therapy to decrease major adverse cardiac events following non-cardiac surgery; (iii) a national prospective observational study of the outcomes associated with paediatric surgical cases; (iv) a national observational study of maternal and fetal outcomes following operative delivery in SA; (v) a steppedwedge trial of an enhanced recovery after surgery programme for (a) surgery, (b) obstetrics, (c) emergency surgery, and (d) trauma surgery; (vi) a stepped-wedge trial of a surgical safety checklist on patient outcomes in SA; (vii) a prospective observational study of perioperativeoutcomes after surgery in district general hospitals in SA; (viii) short-course interventions to improve anaesthetic skills in rural doctors; (ix) studies of the efficacy of simulation training to improve (a) patient outcomes, (b) team dynamics, and (c) leadership; and (x) development and validation of a risk stratification tool for SA surgery based on the South African Surgical Outcomes Study (SASOS) data. CONCLUSIONS. These research priorities provide the structure for an intermediate-term research agenda.The workshop was funded by the Discipline of Anaesthesiology and Critical Care, University of KwaZulu-Natal.http://www.samj.org.zaam2016Anaesthesiolog

Antibacterial antibody responses associated with the development of asthma in house dust mite-sensitised and non-sensitised children

Background Infants who develop house dust mite (HDM) allergy and HDM-sensitised children with severe persistent asthma have low antibody responses to the P6 antigen of Haemophilus influenzae

The infant nasopharyngeal microbiome impacts severity of lower respiratory infection and risk of asthma development

The nasopharynx (NP) is a reservoir for microbes associated with acute respiratory infections (ARIs). Lung inflammation resulting from ARIs during infancy is linked to asthma development. We examined the NP microbiome during the critical first year of life in a prospective cohort of 234 children, capturing both the viral and bacterial communities and documenting all incidents of ARIs. Most infants were initially colonized with Staphylococcus or Corynebacterium before stable colonization with Alloiococcus or Moraxella. Transient incursions of Streptococcus, Moraxella, or Haemophilus marked virus-associated ARIs. Our data identify the NP microbiome as a determinant for infection spread to the lower airways, severity of accompanying inflammatory symptoms, and risk for future asthma development. Early asymptomatic colonization with Streptococcus was a strong asthma predictor, and antibiotic usage disrupted asymptomatic colonization patterns. In the absence of effective anti-viral therapies, targeting pathogenic bacteria within the NP microbiome could represent a prophylactic approach to asthma

Distinguishing benign from pathologic TH2 immunity in atopic children

Although most children with asthma and rhinitis are sensitized to aeroallergens, only a minority of sensitized children are symptomatic, implying the underlying operation of efficient anti-inflammatory control mechanisms