La disponibilite´ de dispositifs alternatifs pour la gestion des voies respiratoires proble´matique dans des services des urgences publics dans la province du Cap Occidental

CITATION: Jooste, W.J.L. & Van Hoving, D.J. 2015. The availability of alternative devices for the management of the difficult airway in public emergency centres in the Western Cape. African Journal of Emergency Medicine, 5(1):19-23. http://dx.doi.org/10.1016/j.afjem.2014.11.001.The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicineThe thesis is available at http://hdl.handle.net/10019.1/102550Introduction: The failed or difficult airway is a rare, but life-threatening situation. Alternative airway devices to direct laryngoscopy are essential aids to manage these scenarios successfully. The aim of this study was to determine which alternative airway devices are currently available in public emergency centres in the Western Cape Province, South Africa. Methods: A cross sectional study was conducted in 15 emergency centres. Data regarding the availability of different classes of alternative airway devices were documented on a standardised data collection sheet by a single investigator via direct observation. Incomplete or non-functional equipment was classified as unavailable. Summary statistics were used to describe the data. Results: Twenty-six different types of alternative airway devices were documented. Three centres (20%) had no alternative airway device. Five centres (33.3%) stocked only one device, three centres (20%) had two devices and four centres (26.7%) had more than two devices. Most centres (n = 12, 80%) stocked supraglottic airways (only one centre (6.7%) had paediatric sizes). Tracheal tube introducers were available in five centres (33.3%). Four centres (26.7%) had video-laryngoscopes, but none had optical laryngoscopes. Retroglottic devices and needle cricothyroidotomy equipment were available in two centres (13.3%). Although surgical cricothyroidotomy equipment was available, the equipment was widely dispersed and only three centres (20%) had pre-packed sets available. None of the specialised paediatric centres had needle cricothyroidotomy equipment readily available. Discussion: The study demonstrated that Western Cape public emergency centres are currently inadequately stocked with regard to alternative airway devices. A guideline regarding the procurement and implementation of these devices is needed.https://www.sciencedirect.com/science/article/pii/S2211419X14001372Publishers versio

Reproducibility of cervical range of motion in patients with neck pain

OBJECTIVE: To assess the intra-rater and inter-rater reproducibility of the measurement of active Range of Motion (ROM) in patients with neck pain using the Cybex Electronic Digital Inclinometer-320 (EDI-320). DESIGN: In an outpatient clinic in a primary care setting 32 patients with at least 2 weeks of pain and/or stiffness in the neck were randomly assessed, in a test- retest design with blinded raters using a standardized measurement protocol. Main outcome measure: Cervical flexion-extension, lateral flexion and rotation was assessed. RESULTS: Reliability expressed by the Intraclass Correlation Coefficient (ICC) was 0.93 (lateral flexion) or higher for intra-rater reliability and 0.89 (lateral flexion) or higher for inter-rater reliability. The 95% limits of agreement for intra-rater agreement, expressing the range of the differences between two ratings were -2.5 +/- 11.1 degrees for flexion-extension, -0.1 +/- 10.4degrees for lateral flexion and -5.9 +/- 13.5 degrees for rotation. For inter-rater agreement the limits of agreement were 3.3 +/- 17.0 degrees for flexion-extension, 0.5 +/- 17.0degrees for lateral flexion and -1.3 +/- 24.6 degrees for rotation. CONCLUSIONS: In general, the intra-rater reproducibility and the inter-rater reproducibility were good. We recommend to compare the reproducibility and clinical applicability of the EDI-320 inclinometer with other cervical ROM measures in symptomatic patients. (aut.ref.

Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial

OBJECTIVE: To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain. DESIGN: Economic evaluation alongside a randomised controlled trial. SETTING: Primary care. PARTICIPANTS: 183 patients with neck pain for at least two weeks recruited by 42 general practitioners and randomly allocated to manual therapy (n=60, spinal mobilisation), physiotherapy (n=59, mainly exercise), or general practitioner care (n=64, counselling, education, and drugs). MAIN OUTCOME MEASURES: Clinical outcomes were perceived recovery, intensity of pain, functional disability, and quality of life. Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year. Differences in mean costs between groups, cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques. RESULTS: The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow up at 52 weeks. The total costs of manual therapy (447 euro; 273 pounds sterling; 402 dollars) were around one third of the costs of physiotherapy (1297 euro) and general practitioner care (1379 euro). These differences were significant: P <0.01 for manual therapy versus physiotherapy and manual therapy versus general practitioner care and P=0.55 for general practitioner care versus physiotherapy. The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care. CONCLUSIONS: Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitione

Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain - A randomized, controlled trial

BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled trial. SETTING: Outpatient care setting in the Netherlands. PATIENTS: 183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks. INTERVENTION: 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education). MEASUREMENTS: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. RESULTS: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant. CONCLUSION: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner. (aut. ref.

Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain - Long-term results from a pragmatic randomized clinical trial

OBJECTIVES: The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year. METHODS: One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were randomized to receive a 6-week treatment strategy of MT once a week, PT twice a week, or GP care once every 2 weeks. The primary outcome measures were perceived recovery, severity of physical dysfunctioning, pain intensity, and functional disability. RESULTS: The differences between groups considered over 1 year were statistically significant (repeated measurements analyses P <0.001 to P=0.02) for all outcomes but borderline for the Neck Disability Index (P=0.06). Higher improvement scores were observed for MT for all outcomes, followed by PT and GP care. The success rate, based on perceived recovery after 13 weeks, was 72% for MT, which was significantly higher than the success rate for continued GP care (42%, P=0.001) but not significantly higher compared with PT treatment (59%, P=0.16). The difference between PT and GP approached statistical significance (P=0.06). After 1 year the success rates were 75%, 63%, and 56%, respectively, and no longer significantly different. CONCLUSIONS: Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-u

Soluble mannose receptor induces proinflammatory macrophage activation and metaflammation

Proinflammatory activation of macrophages in metabolic tissues is critically important in the induction of obesity-induced metaflammation. Here, we demonstrate that the soluble mannose receptor (sMR) plays a direct functional role in both macrophage activation and metaflammation. We show that sMR binds CD45 on macrophages and inhibits its phosphatase activity, leading to an Src/Akt/ NF-kappa B-mediated cellular reprogramming toward an inflammatory phenotype both in vitro and in vivo. Remarkably, increased serum sMR levels were observed in obese mice and humans and directly correlated with body weight. Importantly, enhanced sMR levels increase serum proinflammatory cytokines, activate tissue macrophages, and promote insulin resistance. Altogether, our results reveal sMR as regulator of proinflammatory macrophage activation, which could constitute a therapeutic target for metaflammation and other hyperinflammatory diseases.Diabetes mellitus: pathophysiological changes and therap

The availability of alternative devices for the management of the difficult airway in public emergency centres in the Western Cape

The failed or difficult airway is a rare, but life-threatening situation. Alternative airway devices to direct laryngoscopy are essential aids to manage these scenarios successfully. The aim of this study was to determine which alternative airway devices are currently available in public emergency centres in the Western Cape Province, South Africa. Methods: A cross sectional study was conducted in 15 emergency centres. Data regarding the availability of different classes of alternative airway devices were documented on a standardised data collection sheet by a single investigator via direct observation. Incomplete or non-functional equipment was classified as unavailable. Summary statistics were used to describe the data. Results: Twenty-six different types of alternative airway devices were documented. Three centres (20%) had no alternative airway device. Five centres (33.3%) stocked only one device, three centres (20%) had two devices and four centres (26.7%) had more than two devices. Most centres (n = 12, 80%) stocked supraglottic airways (only one centre (6.7%) had paediatric sizes). Tracheal tube introducers were available in five centres (33.3%). Four centres (26.7%) had video-laryngoscopes, but none had optical laryngoscopes. Retroglottic devices and needle cricothyroidotomy equipment were available in two centres (13.3%). Although surgical cricothyroidotomy equipment was available, the equipment was widely dispersed and only three centres (20%) had pre-packed sets available. None of the specialised paediatric centres had needle cricothyroidotomy equipment readily available. Discussion: The study demonstrated that Western Cape public emergency centres are currently inadequately stocked with regard to alternative airway devices. A guideline regarding the procurement and implementation of these devices is needed

Value of work for employees with a chronic disease

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