The predictive value of a QuantiFERON conversion in the development of active tuberculosis disease in adolescents

This study is an extension of a prospective epidemiological study of TB disease and infection in adolescents in the Worcester and surrounding areas in the Western Cape carried out from 2005 to 2009, in which 6363 participants were enrolled from local public schools. In this follow-on study, a subset of adolescents who were identified to have converted their QFT status during the original study will be followed up and observed for the occurrence of active TB disease over a period of two years. A similar sized, random sample of participants identified to have a QFT status that remained negative throughout the original study will be used as the control group

The clinical use and indications for head computed tomography scans in paediatric ambulatory care (short stay ward and medical emergencies) at a children’s hospital over a one-year period, 1st January-31st December 2013

Background: Computed tomography (CT) imaging is an indispensable tool in the management of acute paediatric illness. It offers quick answers, allowing timely lifesaving decision-making. Clinical evidence is required to maximise its benefits against radiation-exposure risks to patients and cost to the healthcare system. Aims: The study aimed to retrospectively investigate clinical presentation and indications of head CT at a tertiary paediatric hospital. Methods: Records of children presenting with acute illness to the medical emergency unit, excluding trauma, of Red Cross War Memorial Children’s Hospital, Cape Town, over one year (2013) were retrospectively reviewed. Participants were included if they underwent head CT scan within 24 hours of presentation. Clinical data were extracted from records and CT findings reported by a paediatric radiologist. Results: Inclusion criteria were met by 311 patients; 188 (60.5%) were boys. The median age was 39.2 (IQR 12.6-84.0) months. Commonest indications were seizures (n=169;54.3%), reduced level of consciousness (n=140;45.0%), headache (n=74;23.8%) and suspected ventriculoperitoneal shunt (VPS) malfunction (n=61;19.7%). In 217 (69.8%) patients CT showed no adverse findings. In the 94 (30.2%) patients in whom CT abnormalities were detected, the predominant findings were hydrocephalus (n=54;57.4%) and cerebral oedema (n=29;30.9%). Abnormal CT findings were commoner in patients with nausea or vomiting (n=21;9.3%, p=0.05) papilloedema (n=3;1.3%, p=0.015) and long tract signs (n=23;10.2%, p=0.02). Forty-seven patients (15.1%) required surgical intervention after CT of which 40 (85.1%) needed a ventricular drainage procedure. A larger proportion of patients with VPS (25/62;40.3%) required surgical intervention compared to patients without VPS (22/249;8.8%, p <0.001) Conclusion: Most children presenting with acute illness (excluding trauma) and undergoing emergency head CT have normal findings. Patients with ventriculoperitoneal shunts constituted a large proportion of patients requiring intervention after CT. Considerations should be made to use clinical presentation to select patients most likely to benefit from CT

The clinical use and indications for head computed tomography scans in paediatric ambulatory care (short stay ward and medical emergencies) at a children’s hospital over a one-year period, 1st January-31st December 2013

Background: Computed tomography (CT) imaging is an indispensable tool in the management of acute paediatric illness. It offers quick answers, allowing timely lifesaving decision-making. Clinical evidence is required to maximise its benefits against radiation-exposure risks to patients and cost to the healthcare system. Aims: The study aimed to retrospectively investigate clinical presentation and indications of head CT at a tertiary paediatric hospital. Methods: Records of children presenting with acute illness to the medical emergency unit, excluding trauma, of Red Cross War Memorial Children’s Hospital, Cape Town, over one year (2013) were retrospectively reviewed. Participants were included if they underwent head CT scan within 24 hours of presentation. Clinical data were extracted from records and CT findings reported by a paediatric radiologist. Results: Inclusion criteria were met by 311 patients; 188 (60.5%) were boys. The median age was 39.2 (IQR 12.6-84.0) months. Commonest indications were seizures (n=169;54.3%), reduced level of consciousness (n=140;45.0%), headache (n=74;23.8%) and suspected ventriculoperitoneal shunt (VPS) malfunction (n=61;19.7%). In 217 (69.8%) patients CT showed no adverse findings. In the 94 (30.2%) patients in whom CT abnormalities were detected, the predominant findings were hydrocephalus (n=54;57.4%) and cerebral oedema (n=29;30.9%). Abnormal CT findings were commoner in patients with nausea or vomiting (n=21;9.3%, p=0.05) papilloedema (n=3;1.3%, p=0.015) and long tract signs (n=23;10.2%, p=0.02). Forty-seven patients (15.1%) required surgical intervention after CT of which 40 (85.1%) needed a ventricular drainage procedure. A larger proportion of patients with VPS (25/62;40.3%) required surgical intervention compared to patients without VPS (22/249;8.8%, p <0.001) Conclusion: Most children presenting with acute illness (excluding trauma) and undergoing emergency head CT have normal findings. Patients with ventriculoperitoneal shunts constituted a large proportion of patients requiring intervention after CT. Considerations should be made to use clinical presentation to select patients most likely to benefit from CT

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

No Abstrac

South African Guidelines Excellence (SAGE): Adopt, adapt, or contextualise?

Clinical practice guideline (CPG) activities must be planned carefully for efficient use of available resources and evidence-based implementation. De novo development of CPGs may sometimes ‘recreate the wheel’ and delay implementation. Three innovative alternatives to de novo CPG development (adopt, contextualise or adapt) are outlined, which have greater potential than de novo development to best use the limited available resources, personnel and time in settings such as South Africa

Особливості планування і використання робочого часу менеджера

Introduction: Extensive research has been undertaken over the last 30 years on the methods underpinning clinical practice guidelines (CPGs), including their development, updating, reporting, tailoring for specific purposes, implementation and evaluation. This has resulted in an increasing number of terms, tools and acronyms. Over time, CPGs have shifted from opinion-based to evidence-informed, including increasingly sophisticated methodologies and implementation strategies, and thus keeping abreast of evolution in this field of research can be challenging. Methods: This article collates findings from an extensive document search, to provide a guide describing standards, methods and systems reported in the current CPG methodology and implementation literature. This guide is targeted at those working in health care quality and safety and responsible for either commissioning, researching or delivering health care. It is presented in a way that can be updated as the field expands. Conclusion: CPG development and implementation have attracted the most international interest and activity, whilst CPG updating, adopting (with or without contextualization), adapting and impact evaluation are less well addressed.Funding Agencies|South African Medical Research Council</p

Trends in the types and quality of childhood immunisations research output from Africa 1970–2010: mapping the evidence base

Abstract Background Over the past four decades, extraordinary progress has been made in establishing and improving childhood immunization programmes around Africa. In order to ensure effective and sustainable positive growth of these childhood immunisations programmes, the development, adaptation and implementation of all interventions (programme activities, new vaccines, new strategies and policies) should be informed by the best available local evidence. Methods An assessment of the peer-reviewed literature on childhood immunization research published in English from 1970 to 2010 was conducted in PubMed and Africa-Wide databases. All study types were eligible for inclusion. A standard form was used to extract information from all studies identified as relevant and entered into a Microsoft Access database for analysis. Results Our initial search yielded 5436 articles from the two databases, from which 848 full text articles were identified as relevant. Among studies classified as clinical research (417), 40% were clinical trials, 24% were burden of disease/epidemiology and 36% were other clinical studies. Among studies classified as operational research (431), 77% related to programme management, 18% were policy related and 5% were related to vaccine financing. Studies were conducted in 48 African countries with six countries (South Africa, The Gambia, Nigeria, Senegal, Guinea-Bissau and Kenya) accounting for 56% of the total research output. Studies were published in 152 different journals with impact factors ranging from 0.192 to 53.29; with a median impact factor of 3.572. Conclusion A similar proportion of clinical versus operational research output was found. However, an uneven distribution across Africa was observed with only six countries accounting for over half of the research output. The research conducted was of moderate to high quality, with 62% being published in journals with 2010 impact factors greater than two. Urgent attention should be given to the development of research capacity in low performing countries around Africa, with increased focus on the process of turning immunisations programme research evidence into policy and practice, as well as increased focus on issues relating to vaccine financing and sustainability in Africa

Strengthening the expanded programme on immunization in Africa: looking beyond 2015

Shingai Machingaidze and colleagues reflect on the successes and shortfalls of the Expanded Programme on Immunization (EPI) in Africa, and the considerable challenges that must now be addressed to improve immunization systems

South African Guidelines Excellence (SAGE): Clinical practice guidelines - quality and credibility

In this editorial, the first in a series of six, we present issues critical to CPG development and uptake, relevant to South Africa (SA) and beyond. While recent local efforts to improve CPG quality and credibility in SA are commendable, opportunities to progress SA CPG quality and uptake are limited by the lack of a central, nationally recognised and accepted CPG development unit. Such a unit has the potential to significantly increase SA efforts to improve and standardise high-quality, credible CPG development, reporting and uptake. To this end, the Project SAGE (South African Guidelines Excellence) team is engaging in a 3-year stakeholder-driven process that aims to better understand the guideline development arena in SA, and improve the standard of local guideline development, adaptation, contextualisation, and ultimately implementation of primary healthcare guidelines.