Emergency centres lack defibrillator knowledge

The original publication is available at http://www.samj.org.zaIn the emergency centre (EC), a number of essential items of equipment are needed to manage a wide variety of acute life-threatening emergencies. Their correct use depends heavily on the training and experience of personnel. The defibrillator is part of this essential equipment and should be available in all ECs. Although defibrillators are widely available in Western Cape ECs, it is not known whether public sector EC personnel have the knowledge and skills necessary to use them safely and effectively. Most cardiac arrests in adult patients are due to ventricular fibrillation (VF) or cardiac-related causes, and early defibrillation improves survival of such patients1,2 and is therefore an important part of their immediate treatment (combined with the other links of the chain of survival for both in- and out-of-hospital cardiac arrest).Publishers' Versio

Investigating the status of supplementary tuition in the teaching and learning of mathematics

The study seeks to investigate the status of supplementary tuition in the teaching and learning of mathematics and mathematical literacy. The study followed a descriptive survey design involving the use of learner and teacher questionnaires. A convenient sample of mathematics and mathematical literacy teachers together with a stratified sample of their Grade 11 learners were drawn from a purposive sample of highperforming high schools in the East London district of the Eastern Cape, South Africa. The results show that supplementary tuition is popular, especially among girls, and it is in three forms (i.e. private tuition, vacation school and problem-solving classes): Problemsolving classes dominated by working on past/model examination papers is the most preferred; in some instances supplementary tuition is offered for a fee; it is not only confined to poor performing learners; and participation in supplementary tuition is influenced by a variety of factors

Complications of tube thoracostomy for chest trauma

Objective. To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings. Methods. Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department’s records and monthly statistics. Results. A total of 3 989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8%) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92%) of these had been referred with an ICD in situ. An overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity). Conclusion. Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion

Spatial trends in tourism within South Africa : the expected and the surprising

Abstract: Several researchers have highlighted the spatial imbalances of the tourism sector in South Africa. It has been noted that this sector is highly concentrated spatially in terms of its distribution and in relation to its potential local impacts across the country. Although it is broadly understood that the tourism sector is geographically uneven, the lack of sector comparative data at municipal level may inhibit the wide spread use of geographically comparative analyses of the contribution of the various dimensions of tourism in the South African space economy. The aim of this paper is to provide an indication of the value of such comparative analyses of the spatial trends and impacts of the tourism sector in local economies in South Africa. The discussion of the tourism space economy is based on an analysis of a local tourism database which contains details of the tourism performance of all local authorities in the country focussing on the period from 2001 to 2011. Whilst the study confirms the important role of metropolitan areas, secondary and coastal cities and typical tourism destinations in the tourism space economy, it also highlights the significance of some local places/economies that are not traditionally associated with tourism, as well as illustrating the significance of tourism spend in the local economies of a range of municipalities that might not be part of the ‘top’ tourist destinations in South Africa

A retrospective evaluation of the impact of a dedicated obstetric and neonatal transport service on transport times within an urban setting

OBJECTIVE:To determine whether the establishment of a dedicated obstetric and neonatal flying squad resulted in improved performance within the setting of a major metropolitan area.DESIGN AND SETTING:The Cape Town metropolitan service of the Emergency Medical Services was selected for a retrospective review of the transit times for the newly implemented Flying Squad programme. Data were imported from the Computer Aided Dispatch programme. Dispatch, Response, Mean Transit and Total Pre-hospital times relating to the obstetric and neonatal incidents was analysed for 2005 and 2008. RESULTS: There was a significant improvement between 2005 and 2008 in all incidents evaluated. Flying Squad dispatch performance improved from 11.7% to 46.6% of all incidents dispatched within 4 min (p < 0.0001). Response time performance at the 15-min threshold did not demonstrate a statistically significant improvement (p = 0.4), although the improvement in the 30-min performance category was statistically significant in both maternity and neonatal incidents. Maternity incidents displayed the greatest improvement with the 30-min performance increasing from 30.3% to 72.9%. The analysis of the mean transit times demonstrated that neonatal transfers displayed the longest status time in all but one of the categories. Even so, the introduction of the Flying Squad programme resulted in a reduction in a total pre-hospital time from 177 to 128 min. CONCLUSION: The introduction of the Flying Squad programme has resulted in significant improvement in the transit times of both neonatal and obstetric patients. In spite of the severe resource constraints facing developing nations, the model employed offers significant gains

Fracture healing in patients with human immunodeficiency virus in South Africa

Background: Human immunodeficiency virus (HIV) reduces bone mineral density, mineralisation and turnover, and may impair fracture healing. Setting: This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing following trauma. Methods: All adults with acute tibia and femur fractures who underwent intermedullary nailing (IM) for fracture fixation between September 2017 and December 2018, at two tertiary hospitals, were followed for a minimum of 12 months post-operatively. The primary outcome was delayed bone union at 6 months (defined by the radiological union scoring system for the tibia [RUST] score <9), and the secondary outcome was non-union (defined as RUST score <9) at 9 months. Multivariable logistic regression models were constructed to investigate associations between HIV status and impaired fracture healing. Results: In total, 358 participants, who underwent 395 IM nailings, were enrolled in the study and followed up for 12 months. Seventy-one participants (71/358, 19·8%) were HIV positive (83 IM nailings [83/395], 21.0%). HIV was not associated with delayed fracture healing after IM nailing of the tibia or femur (multivariable odds ratio [OR]: 1·06; 95% confidence interval [CI]: 0·50–2·22). Participants with HIV had a statistically significant lower odds of non-union compared to HIV-negative participants (multivariable OR: 0·17; 95% CI: 0·01–0·92). Conclusions: Fractures sustained in HIV-positive individuals can undergo surgical fixation as effectively as those in individuals who are HIV negative, with no increased risk of delayed union or non-union

Is human immunodeficiency virus a risk factor for the development of nonunion?—a case–control study

Objective: Human immunodeficiency virus (HIV) infection has been suggested to be associated with an increased risk of the development of nonunion after a fracture. This prospective matched case–control study in South Africa investigated common risk factors, including HIV status, that influence the development of a nonunion after a femur or tibia fracture. Methods: Adult participants (cases) with established nonunions of the femur or tibia shaft were recruited over a 16-month period, between December 2017 and April 2019. They were matched for (1) age; (2) sex; (3) fracture site; and (4) fracture management type, with “control” participants who progressed to fracture union within 6 months of injury. All participants were tested for HIV. Multivariable logistic regression models were constructed to investigate associations between known risk factors for the development of nonunion and impaired fracture healing. Results: A total of 57 cases were matched with 57 “control” participants (44/57 male, 77.2% vs. 13/57 female, 22.8%, median age 36 years). HIV status was not associated with the development of nonunion after the management of tibia and femur fractures, on both univariate (odds ratio, 0.40; confidence interval, 0.10–1.32; P = 0.151) or multivariable (odds ratio, 0.86; confidence interval, 0.18–3.73; P = 0.831) analysis. No other confounding factors were shown to have any statistically significant impact on the odds of developing nonunion in this study cohort. Conclusion: This study demonstrates that HIV does not seem to increase the risk of the development of nonunion and HIV-positive individuals who sustain a fracture can be managed in the same manner as those who are HIV negative