The introduction of an acute physiological support service for surgical patients is an effective error reduction strategy

AbstractIntroductionAcute surgical patients are particularly vulnerable to human error. The Acute Physiological Support Team (APST) was created with the twin objectives of identifying high-risk acute surgical patients in the general wards and reducing both the incidence of error and impact of error on these patients. A number of error taxonomies were used to understand the causes of human error and a simple risk stratification system was adopted to identify patients who are particularly at risk of error.ResultsDuring the period November 2012–January 2013 a total of 101 surgical patients were cared for by the APST at Edendale Hospital. The average age was forty years. There were 36 females and 65 males. There were 66 general surgical patients and 35 trauma patients. Fifty-six patients were referred on the day of their admission. The average length of stay in the APST was four days. Eleven patients were haemo-dynamically unstable on presentation and twelve were clinically septic. The reasons for referral were sepsis,4 respiratory distress,3 acute kidney injury AKI (38), post-operative monitoring (39), pancreatitis,3 ICU down-referral,7 hypoxia,5 low GCS,1 coagulopathy.1 The mortality rate was 13%. A total of thirty-six patients experienced 56 errors. A total of 143 interventions were initiated by the APST. These included institution or adjustment of intravenous fluids (101), blood transfusion,12 antibiotics,9 the management of neutropenic sepsis,1 central line insertion,3 optimization of oxygen therapy,7 correction of electrolyte abnormality,8 correction of coagulopathy.2ConclusionOur intervention combined current taxonomies of error with a simple risk stratification system and is a variant of the defence in depth strategy of error reduction. We effectively identified and corrected a significant number of human errors in high-risk acute surgical patients. This audit has helped understand the common sources of error in the general surgical wards and will inform on-going error reduction initiatives

The Dark Energy Survey : more than dark energy – an overview

This overview paper describes the legacy prospect and discovery potential of the Dark Energy Survey (DES) beyond cosmological studies, illustrating it with examples from the DES early data. DES is using a wide-field camera (DECam) on the 4 m Blanco Telescope in Chile to image 5000 sq deg of the sky in five filters (grizY). By its completion, the survey is expected to have generated a catalogue of 300 million galaxies with photometric redshifts and 100 million stars. In addition, a time-domain survey search over 27 sq deg is expected to yield a sample of thousands of Type Ia supernovae and other transients. The main goals of DES are to characterize dark energy and dark matter, and to test alternative models of gravity; these goals will be pursued by studying large-scale structure, cluster counts, weak gravitational lensing and Type Ia supernovae. However, DES also provides a rich data set which allows us to study many other aspects of astrophysics. In this paper, we focus on additional science with DES, emphasizing areas where the survey makes a difference with respect to other current surveys. The paper illustrates, using early data (from ‘Science Verification’, and from the first, second and third seasons of observations), what DES can tell us about the Solar system, the Milky Way, galaxy evolution, quasars and other topics. In addition, we show that if the cosmological model is assumed to be +cold dark matter, then important astrophysics can be deduced from the primary DES probes. Highlights from DES early data include the discovery of 34 trans-Neptunian objects, 17 dwarf satellites of the Milky Way, one published z > 6 quasar (and more confirmed) and two published superluminous supernovae (and more confirmed)

Risk behaviour of HIV positive individuals who are aware of their serostatus: evidence from the 2012 HIV Population-based Household Survey in South Africa

HIV positive people are the main source of new infections, which occur mainly through risk behaviours with a high-risk partner. Awareness of HIV status has been proposed as a key factor underlying sexual and HIV risk behaviour. This study sought to determine whether awareness of one's HIV positive status translates to reduced sexual risk behaviour among HIV positive individuals. The analysis was based on the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey, which included socio-demographic characteristics, age at sexual debut, age disparate partnerships, multiple sexual partners, condom use at last sex, self-perceived risk of HIV infection and alcohol use. Bivariate and multivariate logistic regression was used to assess sexual and HIV risk behavioural factors associated with awareness of HIV status. Of 2565 HIV positive individuals, 48.3% reported that they were aware of their HIV status while the remainder indicated they were aware not aware of their HIV status. HIV positive females were more likely to report that they knew their status than their male counterparts [OR=1.6 (95% CI: 1.0-2.7), p=0.049]. Knowing that one was HIV positive was associated with increased likelihood of condom at last sex [OR=1.5 (95% CI: 1.1-2.0), p=0.010], low risk perception of HIV infection ([OR=0.7 (95% CI: 0.5-0.9), p=0.011], and reduced likelihood of risky/hazardous drinking of alcohol among males [OR=0.3 (95% CI: 0.2-0.6), p<0.001]. The current findings confirm that gaining knowledge of one's own HIV status is key to adopting HIV prevention behaviours. Given the large number of people living with HIV/AIDS in South Africa more efforts should be made to promote positive prevention programmes.

The South African Marang men's project

To date, there is a dearth of surveillance data on the prevalence of HIV and associated risk behaviours among men who have sex with men (MSM) in South Africa. This is particularly true for data collected from several sites using the same sampling approach. This study called the Marang Men's Project was undertaken to fill this information gap. It was implemented among MSM in the three largest cities of South Africa, namely, Cape Town in the Western Cape, Durban in KwaZulu-Natal and Johannesburg in Gauteng. The high HIV prevalence estimates found in our study among MSM in each of the three study cities call for a need to implement a national HIV bio-behavioural surveillance programme for MSM. The Marang Men's Project has demonstrated that there is an urgent need for interventions, which respond not only to the heterosexual HIV epidemic but also to the HIV epidemic among MSM in South Africa. This survey therefore provides valuable information to SANAC, the national and provincial Departments of Health (DoHs), and lesbian, gay, bisexual, transgender and intersex (LGBTI) organisations to both implement and advocate for improved programmes for the health of MSM.

Developing a prevention with positives (PWP) package for key populations in Cape Town, Johannesburg and Durban, South Africa

Poster presentation at the Provincial Research Day: Quality of Care: the patient centered experience, Lentegeur Hospital Conference Centre, Mitchells Plain, Cape Town, 4 Octobe

"You will be discriminated because of like your sexual preference": are public health care practitioners sensitized to providing care, treatment and counselling to key populations in South Africa?

Poster presentation at the XI International AIDS Impact Conference, Barcelona, Spain, 29 September-2 Octobe

Lessons learnt in a HIV behavioural survey using respondent driven sampling (RDS) among men who have sex with men (MSM) in three South African cities

Poster presentation at the 6th SA AIDS Conference, Durban, 18-21 Jun

Cost-effectiveness of a primary care based physical activity intervention in 45-74 year old men and women: a randomised controlled trial.

The article was first published in:British Journal of Sports Medicine 1998:32:236-241.OBJECTIVE: To assess the cost-effectiveness of a primary care based intervention aimed at increasing levels of physical activity in inactive people aged 45-74. METHODS: A total of 714 inactive people aged 45-74, taken from two west London general practices, were randomised into two groups. Intervention subjects were invited to a consultation with an exercise development officer, and offered a personalised 10 week programme to increase their level of regular physical activity, combining leisure centre and home based activities. Control subjects were sent information on local leisure centres. All subjects were followed up at eight months. RESULTS: There was a net 10.6% (95% confidence interval 4.5 to 16.9%) reduction in the proportion of people classified as sedentary in the intervention group compared with the control group, eight months after the intervention. The intervention group also reported an increase in the mean number of episodes of physical activity per week, as compared with the control group (an additional 1.52 episodes (95% confidence interval 1.14 to 1.95)). The cost of moving a person out of the sedentary group was shown to be less than 650 Pounds. The cost of moving someone to the now commonly recommended level was estimated at almost 2500 Pounds. CONCLUSIONS: Moderate physical activity can be successfully encouraged in previously sedentary men and women aged 45-74 through a primary care based intervention. The process of recruitment was the most important variable cost. A high uptake rate would maximise cost-effectiveness, and sensitivity analysis suggests that unit costs could be halved with a more effective recruitment strategy.This trial was supported by West London Health Promotion Agency through a grant awarded by North Thames NHS Executive Responsive Funding programme (RFG013

Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa

Introduction and Setting: Our analysis compares the most comprehensive epidemiologic and virologic surveillance data compiled to date for laboratory-confirmed H1N1pdm patients between 1 April 2009 - 31 January 2010 from five temperate countries in the Southern Hemisphere-Argentina, Australia, Chile, New Zealand, and South Africa. Objective: We evaluate transmission dynamics, indicators of severity, and describe the co-circulation of H1N1pdm with seasonal influenza viruses. Results: In the five countries, H1N1pdm became the predominant influenza strain within weeks of initial detection. South Africa was unique, first experiencing a seasonal H3N2 wave, followed by a distinct H1N1pdm wave. Compared with the 2007 and 2008 influenza seasons, the peak of influenza-like illness (ILI) activity in four of the five countries was 3-6 times higher with peak ILI consultation rates ranging from 35/1,000 consultations/week in Australia to 275/100,000 population/week in New Zealand. Transmission was similar in all countries with the reproductive rate ranging from 1.2-1.6. The median age of patients in all countries increased with increasing severity of disease, 4-14% of all hospitalized cases required critical care, and 26-68% of fatal patients were reported to have ≥1 chronic medical condition. Compared with seasonal influenza, there was a notable downward shift in age among severe cases with the highest population-based hospitalization rates among children <5 years old. National population-based mortality rates ranged from 0.8-1.5/100,000. Conclusions: The difficulty experienced in tracking the progress of the pandemic globally, estimating its severity early on, and comparing information across countries argues for improved routine surveillance and standardization of investigative approaches and data reporting methods