Piloting a trauma surveillance tool for primary healthcare emergency centres

Objective. We aimed to pilot a trauma surveillance tool for use ina primary healthcare emergency centre to provide a risk profile ofinjury patterns in Elsies River, Cape Town.Methods. Healthcare workers completed a one-page questionnairecapturing demographic and injury data from trauma patients presenting to the emergency unit of the Elsies River Community Health Centre over a period of 10 days.Results. Trauma cases comprised about one-fifth of the total headcount during the study period. Most injuries took place before midnight. Approximately 47% of the trauma patients were suspected of being under the influence of alcohol with 87% of these cases caused by interpersonal violence; 28% were males between 19 and 35 years old, suspected of being under the influence of alcohol and presenting with injuries due to violence.Conclusion. Injury surveillance at primary healthcare emergency centres provides an additional perspective on the injury burden compared with population-level mortality statistics, but the quality of data collection is limited by resource constraints. We recommend that the current trauma register be revised to separate trauma and medical headcounts and enable better resource planning at a facility and subdistrict level. Information gathered must be linked to health and safety interventions aimed at reducing the trauma burden within communities

Home versus hospital-based cardiac rehabilitation: A systematic review

Comprehensive cardiac rehabilitation has positive effects on many cardiac risk factors (physical activity, smoking status, cholesterol, anxiety and depression) and can lead to improvements in mortality, morbidity and quality of life. Most formal cardiac rehabilitation in the UK is offered within a hospital or centre setting, although this may not always be convenient or accessible for many cardiac patients, especially those in remote areas. The proportion of eligible patients who successfully complete a cardiac rehabilitation program remains low. There are many reasons for this but geographical isolation and transport issues are important. This systematic review examines the current evidence for home- versus hospital-based cardiac rehabilitation. Home-based cardiac rehabilitation offers greater accessibility to cardiac rehabilitation and has the potential to increase uptake. While there have been fewer studies of home-based cardiac rehabilitation, the available data suggest that it has comparable results to hospital-based programs. Many of these studies are small and heterogeneous in terms of interventions but home-based cardiac rehabilitation appears both safe and effective. Available evidence suggests that it results in longer lasting maintenance of physical activity levels compared with hospital-based rehabilitation and is equally effective in improving cardiac risk factors. Furthermore, it has the potential to be a more cost-effective intervention for patients who cannot easily access their local centre or hospital. Currently home-based cardiac rehabilitation is not offered routinely to all patients but it appears to have the potential to increase uptake in patients who are unable, or less likely, to attend more traditional hospital-based cardiac rehabilitation programs

Conflict of interest: A tenacious ethical dilemma in public health policy, not only in clinical practice/research

In addition to the ethical practice of individual health professionals, bioethical debate about conflict of interest (CoI) must include theinstitutional ethics of public policy-making, as failure to establish independence from powerful stakeholder influence may pervert publichealth goals. All involved in public policy processes are accountable for CoI, including experts, scientists, professionals, industry and government officials. The liquor industry in South Africa is presented as a case study. Generic principles of how to identify, manage and address CoI are discussed. We propose that health professionals and policy makers should avoid partnering with industries that are harmful to health. Regarding institutional CoI, we recommend that there should be effective policies, procedures and processes for governing public-private joint ventures with such industries. These include arms-length funding, maintaining the balance between contesting vested interests, and full disclosure of the identity and affiliations of all participants in structures and reports pertaining to public policy-making

Reducing the burden of injury: An intersectoral preventive approach is needed

Injuries constitute the second largest contributor to the Western Cape burden of disease (BoD), after major infectious diseases caused by HIV/AIDS and tuberculosis and ahead of mental health disorders and cardiovascular and childhood diseases. The Provincial Health Department instituted the BoD Reduction Project to improve health surveillance for planning and resource allocation, review risk factors, and prioritise interventions to reduce the overall BoD

Conflict of interest: A tenacious ethical dilemma in public health policy not only in clinical practice/research

In addition to the ethical practice of individual health professionals, bioethical debate about conflict of interest (CoI) must include the institutional ethics of public policy-making, as failure to establish independence from powerful stakeholder influence may pervert public health goals. All involved in public policy processes are accountable for CoI, including experts, scientists, professionals, industry and government officials. The liquor industry in South Africa is presented as a case study. Generic principles of how to identify, manage and address CoI are discussed. We propose that health professionals and policy makers should avoid partnering with industries that are harmful to health. Regarding institutional CoI, we recommend that there should be effective policies, procedures and processes for governing public-private joint ventures with such industries. These include arms-length funding, maintaining the balance between contesting vested interests, and full disclosure of the identity and affiliations of all participants in structures and reports pertaining to public policy-making

Piloting a trauma surveillance tool for primary healthcare emergency centres

Objective. We aimed to pilot a trauma surveillance tool for use in a primary healthcare emergency centre to provide a risk profile of injury patterns in Elsies River, Cape Town. Methods. Healthcare workers completed a one-page questionnaire capturing demographic and injury data from trauma patients presenting to the emergency unit of the Elsies River Community Health Centre over a period of 10 days. Results. Trauma cases comprised about one-fifth of the total headcount during the study period. Most injuries took place before midnight. Approximately 47% of the trauma patients were suspected of being under the influence of alcohol with 87% of these cases caused by interpersonal violence; 28% were males between the ages of 19 and 35 years old, suspected of being under the influence of alcohol and presenting with injuries due to violence. Conclusion. Injury surveillance at primary healthcare emergency centres provides an additional perspective on the injury burden compared with population-level mortality statistics, but the quality of data collection is limited by resource constraints. We recommend that the current trauma register be revised to separate trauma and medical headcounts and enable better resource planning at a facility and subdistrict level. Information gathered must be linked to health and safety interventions aimed at reducing the trauma burden within communities

Vooronderzoek meidoornsterfte duingebied Oost-Ameland

AbstractPurposeEvidence for the recommendation to deliver Cognitive Behavioural Therapy (CBT) and Family Interventions (FI) to under-18s with psychosis derives from adult research, and no previous study has focused exclusively on an adolescent population. We evaluated adaptations of these therapies for adolescent inpatients with psychosis (CBTpA and FIpA), delivered as an adjunct to inpatient standard care (SC).Subjects and methodsThirty adolescent inpatients with psychotic symptoms on admission were sequentially allocated to receive CBTpA + SC (n = 10); FIpA + SC (n = 10) or SC alone (n = 10). Psychotic symptoms and functioning were measured at admission and discharge.ResultsGroup comparisons did not reach conventional significance, but effect sizes in this pilot study showed a promising impact of CBTpA compared to SC alone, in reducing symptoms (ES: d = 0.6), with smaller effect sizes for functioning (d = 0.2) and for FIpA (symptoms, d = 0.1 and functioning, d = 0.4). There was no advantage of either additional treatment in reducing length of stay, but self-report satisfaction ratings were higher for both psychological therapies.Discussion and conclusionsThe study is the first to focus on an exclusively adolescent population, using appropriately adapted therapy protocols. Findings suggest that the interventions are feasible, acceptable and helpful for adolescents with psychosis. Larger randomised controlled trials are now needed.</jats:sec

Supported discharge service versus Inpatient care Evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes.

Background: Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. Aim: To undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. Method: 106 patients aged 12-18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomization, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. Results: At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (5 or more) of self-harm (OR=0·18, 95% CI: 0·05 to 0·64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28·2 to 208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. Conclusion: The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment

Variegate porphyria in South Africa, 1688 - 1996 - new developments in an old disease

Variegate porphyria, an autosomal dominant inherited trait resulting in decreased activity of protoporphyrinogen oxidase, the penuttimate haem biosynthetic enzyme, is characterised clinically by photosensitive skin disease and a propensity to acute neurovisceral crises. The disease has an exceptionally high frequency in South Africa,owing to a founder effect. The specific mutation in the protoporphynnogen oxidase gene sequence which represents this founder gene has been identified. Genetic diagnosis is therefore now possible in families in whom the gene defect is known. However, the exact nature and degree of activity of the porphyria can only be determined by detailed quantitative biochemical analysis of excreted porphyrins. The relative contributions of the acute attack and the skin disease to the total disease burden of patients with variegate porphyria is not static, and in South Africa there have been significant changes over the past 25 years, with fewer patients presenting with acute attacks, leaving a greater proportion to present with skin disease or to remain asymptomatic with the diagnosis being made in the laboratory. The most common precipitating cause of the acute attack of VP is administration of porphyrinogenic drugs. Specific suppression of haem synthesis with intravenous haem arginate is the most useful treatment of a moderate or severe acute attack. Although cutaneous lesions are limited to the sun-exposed areas, management of the skin disease of VP remains inadequate