Antifibrinolytic drugs for acute traumatic injury

In South Africa, trauma is a major concern, with violence and road traffic accidents being the fifth and seventh leading causes of death, respectively. Antifibrinolytic agents have been used in trauma and major surgery to prevent fibrinolysis and reduce blood loss. We highlight an updated Cochrane review investigating the effect of antifibrinolytic drugs in patients with acute traumatic injury. The review authors conducted  comprehensive literature searches in January 2015 with regard to all randomised  controlled trials comparing antifibrinolytic agents after acute traumatic injury. Three randomised controlled trials, of which two (n=20 451) assessed the effect of  tranexamic acid (TXA), were included. The authors concluded that TXA safely reduces  mortality in trauma with bleeding without increasing the risk of adverse events. TXA should be administered as early as possible, and within 3 hours of injury. There is still uncertainty with regard to the effect of TXA on patients with traumatic brain injury; however, ongoing randomised controlled trials should shed more light on this

Cost Optimization in Disruption Conditions: A Case Study in Small Medium Enterprise

Purpose: The objective of this study was to design a cost optimization model that offers production improvement for SMEs.                                                                                                          Theoretical framework: Several studies related to production system disruption management have been conducted, with the majority focusing on large companies. However, small and medium enterprises (SMEs) have limitations compared to large companies. Repairability is considered for cost optimization.                                                    Design/methodology/approach:  This research designed a cost optimization model that offers production improvement with repairability process for SME.   Findings: There is a need for repairability given the disruption caused by defective products in SMEs. There is a clear difference in total profit between the current state without repairability and proposed conditions with repairability. SMEs suffer massive losses in the absence of repairs, assuming they do not consider repairing defective products with a production defect rate of approximately 15%. The current state produces many downgraded products. However, repairability still needs to be improved to increase profits.   Research, Practical & Social implications: The study implied that there is a need to consider repairability for product defects at SMEs, especially those with a 15% product defect rate. The use of the proposed model optimizes profit and is designed to increase production capacity based on product improvements. Repairability was considered in this research, considering that SMEs are more susceptible to disruptions compared to large companies.   Originality/value: The novelty of this paper is adding process repairability to the cost optimization model for SMEs in the textile sector, then considering the product downgrade under the conditions in SMEs

Antifibrinolytic drugs for acute traumatic injury

In South Africa, trauma is a major concern, with violence and road traffic accidents being the fifth and seventh leading causes of death, respectively. Antifibrinolytic agents have been used in trauma and major surgery to prevent fibrinolysis and reduce blood loss. We highlight an updated Cochrane review investigating the effect of antifibrinolytic drugs in patients with acute traumatic injury. The review authorsconducted comprehensive literature searches in January 2015 with regard to all randomised controlled trials comparing antifibrinolytic agents after acute traumatic injury. Three randomised controlled trials, of which two (n=20 451) assessed the effect of tranexamic acid (TXA), were included. The authors concluded that TXA safely reduces mortality in trauma with bleeding without increasing the risk ofadverse events. TXA should be administered as early as possible, and within 3 hours of injury. There is still uncertainty with regard to the effect of TXA on patients with traumatic brain injury; however, ongoing randomised controlled trials should shed more light on this

Editorial: South African Guidelines Excellence (SAGE): Efficient, effective and unbiased clinical practice guideline teams

No Abstrac

Evidence synthesis workshops: moving from face-to-face to online learning

Postgraduate training is moving from face-to-face workshops or courses to online learning to help increase access to knowledge, expertise and skills, and save the cost of face-to-face training. However, moving from face-to-face to online learning for many of us academics is intimidating, and appears even more difficult without the help of a team of technologists. In this paper, we describe our approach, our experiences and the lessons we learnt from converting a Primer in Systematic Reviews face-to-face workshop to a 6-week online course designed for healthcare professionals in Africa. We learnt that the team needs a balance of skills and experience, including technical know-how and content knowledge; that the learning strategies needed to achieve the learning objectives must match the content delivery. The online approach should result in both building knowledge and developing skills, and include interactive and participatory approaches. Finally, the design and delivery needs to keep in mind the limited and expensive internet access in some resource-poor settings in Africa

Building capacity for development and implementation of clinical practice guidelines

Robust, reliable and transparent methodologies are necessary to ensure that clinical practice guidelines (CPGs) meet international criteria. In South Africa (SA) and other low- and middle-income countries, upskilling and training of individuals in the processes of CPG development is needed. Since de novo CPG development is time-consuming and expensive, new emerging CPG-development approaches (adopting, contextualising, adapting and updating existing good-quality CPGs) are potentially more appropriate for our context. These emerging CPG-development methods are either not included or sparsely covered in existing training opportunities. The SA Guidelines Excellence (SAGE) team has responded innovatively to the need for CPG training in SA. We have revised an existing SA course and developed an online, open-access CPG-development toolkit. This Guideline Toolkit is a comprehensive guideline resource designed to assist individuals who are interested in knowing how to develop CPGs. Findings from the SAGE project can now be implemented with this innovative CPG training programme. This level of CPG capacity development has the potential to influence CPG knowledge, development, practices and uptake by clinicians, managers, academics and policy-makers around the country

The Cochrane Corner in the SAMJ: Summaries of Cochrane systematic reviews for evidence-informed practice

This editorial introduces a regular contribution from Cochrane South Africa (http://www.mrc.ac.za/cochrane/cochrane.htm) to the South African Medical Journal, which will be called the ‘Cochrane Corner’. Our contribution takes the form of technical summaries of Cochrane systematic reviews handpicked for their relevance to South Africa and the African region. Our goal is to help ensure that the high-quality evidence in Cochrane reviews reaches a wider audience.