Spinal cord stimulation for the management of pain: Recommendations for best clinical practice

Spinal cord stimulation (SCS) is an accepted method of pain control. SCS has been used for many years and is supported by a substantial evidence base. A multidisciplinary consensus group has been convened to create a guideline for the implementation and execution of an SCS programme for South Africa (SA). This article discusses the evidence and appropriate context of SCS delivery, and makes recommendations for patient selection and appropriate use. The consensus group has also described the possible complications following SCS. This guideline includes a literature review and a summary of controlled clinical trials of SCS. The group notes that, in SA, SCS is performed mainly for painful neuropathies, failed back surgery, and chronic regional pain syndrome. It was noted that SCS is used to treat other conditions such as angina pectoris and ischaemic conditions, which have therefore been included in this guideline. These recommendations give guidance to practitioners delivering this treatment, to those who may wish to refer patients for SCS, and to those who care for patients with stimulators in situ. The recommendations also provide a resource for organisations that fund SCS. This guideline has drawn on the guidelines recently published by the British Pain Society, and parts of which have beenreproduced with the society’s permission. These recommendations have been produced by a consensus group of relevant healthcare professionals. Opinion from outside the consensus group has been incorporated through consultation with representatives of all groups for whom these  recommendations have relevance. The recommendations refer to the current body of evidence relating to SCS. The consensus group wishes to acknowledge and thank the task team of the British Pain Society for their help and input into this document

Labour epidural analgesia audit in a tertiary state hospital in South Africa

Background: Neuraxial analgesia is currently considered the most effective method of labour analgesia. While well studied in developed countries, it is uncertain whether the results, particularly regarding epidural analgesia complication rates, can be extrapolated to the context of the South African public hospital.Method: A retrospective one-year audit reviewed available records for indications for-, complications of-, and patient satisfaction with labour epidural analgesia at Tygerberg Hospital, Western Cape.Results: During the period audited, 157 (2.2%) of 7 005 parturients received labour epidural analgesia. One hundred and forty nine records were retrieved for analysis. Epidural analgesia was not provided on patient request. Rather, specific indications for epidural analgesia in 73.2% of these cases were preeclampsia, cardiovascular disease and morbid obesity. The incidence of complications was 32.3%, comprising hypotension (13.4%) and all other complications (18.9%). Most complications were minor and self-limiting (97.9%). One serious adverse event (cardiac arrest) due to accidental intravenous infusion of bupivacaine was recorded. Resuscitation with lipid emulsion was successful. Parturients reported being “happy” or “very happy” (50% and 36% respectively) with epidural analgesia.Conclusions: At this tertiary referral hospital in the Western Cape, only 2.2% of parturients received labour epidural analgesia, possibly because of personnel time constraints. Indications comprised predominantly preeclampsia, cardiovascular disease and morbid obesity. The incidence of complications from labour epidural analgesia was in line with that observed in developed countries. Most patients were happy with their analgesia. This audit identifies an urgent need for improvement of the labour epidural service at this institution.Keywords: analgesia, complications, epidural, labour indication

Serogrouping and sulphonamide sensitivity of Neisseria meningitidis isolates from the south-western Cape

CITATION: Donald, P.R. et al. 1989. Serogrouping and sulphonamide sensitivity of Neisseria meningitidis isolates from the south-western Cape. S Afr Med J, 76:453.The original publication is available at http://www.samj.org.zaNeisseria meningitidis infections were first reported from the south-western Cape Province in 1883. Since then, against a backdrop of a relatively low incidence with winter exacerbation, epidemic periods have occurred at 10 - IS-year intervals. During the 1978 - 1979 epidemic more than 95% of isolates at Tygerberg Hospital were of serogroup B and only 5% were resistant to sulphonamides. Seventy-seven per cent of patients notified as suffering from meningococcal infections were under 4 years of age.3 In this report we briefly describe the pattern of serogrouping and sulphonamide resistance of N. meningitidis for the period 1980 - 1987.Publisher’s versio

Propagation of Radiosonde Pressure Sensor Errors to Ozonesonde Measurements

Several previous studies highlight pressure (or equivalently, pressure altitude) discrepancies between the radiosonde pressure sensor and that derived from a GPS flown with the radiosonde. The offsets vary during the ascent both in absolute and percent pressure differences. To investigate this problem further, a total of 731 radiosonde-ozonesonde launches from the Southern Hemisphere subtropics to Northern mid-latitudes are considered, with launches between 2005 - 2013 from both longer-term and campaign-based intensive stations. Five series of radiosondes from two manufacturers (International Met Systems: iMet, iMet-P, iMet-S, and Vaisala: RS80-15N and RS92-SGP) are analyzed to determine the magnitude of the pressure offset. Additionally, electrochemical concentration cell (ECC) ozonesondes from three manufacturers (Science Pump Corporation; SPC and ENSCI-Droplet Measurement Technologies; DMT) are analyzed to quantify the effects these offsets have on the calculation of ECC ozone (O3) mixing ratio profiles (O3MR) from the ozonesonde-measured partial pressure. Approximately half of all offsets are 0.6 hPa in the free troposphere, with nearly a third 1.0 hPa at 26 km, where the 1.0 hPa error represents 5 persent of the total atmospheric pressure. Pressure offsets have negligible effects on O3MR below 20 km (96 percent of launches lie within 5 percent O3MR error at 20 km). Ozone mixing ratio errors above 10 hPa (30 km), can approach greater than 10 percent ( 25 percent of launches that reach 30 km exceed this threshold). These errors cause disagreement between the integrated ozonesonde-only column O3 from the GPS and radiosonde pressure profile by an average of +6.5 DU. Comparisons of total column O3 between the GPS and radiosonde pressure profiles yield average differences of +1.1 DU when the O3 is integrated to burst with addition of the McPeters and Labow (2012) above-burst O3 column climatology. Total column differences are reduced to an average of -0.5 DU when the O3 profile is integrated to 10 hPa with subsequent addition of the O3 climatology above 10 hPa. The RS92 radiosondes are superior in performance compared to other radiosondes, with average 26 km errors of -0.12 hPa or +0.61 percent O3MR error. iMet-P radiosondes had average 26 km errors of -1.95 hPa or +8.75 percent O3MR error. Based on our analysis, we suggest that ozonesondes always be coupled with a GPS-enabled radiosonde and that pressure-dependent variables, such as O3MR, be recalculated-reprocessed using the GPS-measured altitude, especially when 26 km pressure offsets exceed 1.0 hPa 5 percent

Spinal cord stimulation for the management of pain: Recommendations for best clinical practice

Spinal cord stimulation (SCS) is an accepted method of pain control. SCS has been used for many years and is supported by a substantial evidence base. A multidisciplinary consensus group has been convened to create a guideline for the implementation and execution of an SCS programme for South Africa (SA). This article discusses the evidence and appropriate context of SCS delivery, and makes recommendations for patient selection and appropriate use. The consensus group has also described the possible complications following SCS. This guideline includes a literature review and a summary of controlled clinical trials of SCS. The group notes that, in SA, SCS is performed mainly for painful neuropathies, failed back surgery, and chronic regional pain syndrome. It was noted that SCS is used to treat other conditions such as angina pectoris and ischaemic conditions, which have therefore been included in this guideline. These recommendations give guidance to practitioners delivering this treatment, to those who may wish to refer patients for SCS, and to those who care for patients with stimulators in situ. The recommendations also provide a resource for organisations that fund SCS. This guideline has drawn on the guidelines recently published by the British Pain Society, and parts of which have been reproduced with the society’s permission. These recommendations have been produced by a consensus group of relevant healthcare professionals. Opinion from outside the consensus group has been incorporated through consultation with representatives of all groups for whom these recommendations have relevance. The recommendations refer to the current body of evidence relating to SCS. The consensus group wishes to acknowledge and thank the task team of the British Pain Society for their help and input into this document

Capacity Building for GIS-based SDG Indicator Analysis with Global High-resolution Land Cover Datasets

The support of geospatial data and technologies for the United Nations Sustainable Development Goals (SDG) framework is critical for assessing and monitoring key indicators, revealing the planet’s trajectory towards sustainability. The availability of global open geospatial datasets, especially high-resolution land cover datasets, provides significant opportunities for computing and comparing indicators across different regions and scales. However, barriers to their proficient use remain due to a lack of data awareness, management and processing capacities using geographic information systems software. To address this, the”Capacity Building for GIS-based SDG Indicator Analysis with Global High-resolution Land Cover Datasets” project created open training material on discovering, accessing, and manipulating global geospatial datasets for computing SDG indicators. The material focuses on water and terrestrial ecosystems, urban environments, and climate, by leveraging world-class global geospatial datasets and using the Free and Open Source Software QGIS. The training material is released under a Creative Commons Attribution 4.0 License, ensuring broad accessibility and facilitating continuous improvement

CAPACITY BUILDING FOR GIS-BASED SDG INDICATORS ANALYSIS WITH GLOBAL HIGH-RESOLUTION LAND COVER DATASETS

The support of geospatial data and technologies for the United Nations Sustainable Development Goals (SDG) framework is critical for assessing and monitoring key indicators, revealing the planet’s trajectory towards sustainability. The availability of global open geospatial datasets, especially high-resolution land cover datasets, provides significant opportunities for computing and comparing indicators across different regions and scales. However, barriers to their proficient use remain due to a lack of data awareness, management and processing capacities using geographic information systems software. To address this, the ”Capacity Building for GIS-based SDG Indicator Analysis with Global High-resolution Land Cover Datasets” project created open training material on discovering, accessing, and manipulating global geospatial datasets for computing SDG indicators. The material focuses on water and terrestrial ecosystems, urban environments, and climate, by leveraging world-class global geospatial datasets and using the Free and Open Source Software QGIS. The training material is released under a Creative Commons Attribution 4.0 License, ensuring broad accessibility and facilitating continuous improvement

Reflections on a decade of delivering PMTCT in Khayelitsha, South Africa

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