Assessment of documented adherence to critical actions in paediatric emergency care at a district-level public hospital in South Africa

CITATION: Berends, E. A., et al. 2021. Assessment of documented adherence to critical actions in paediatric emergency care at a district-level public hospital in South Africa. African Journal of Emergency Medicine, 11(1):98-104, doi:10.1016/j.afjem.2020.09.001.The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicineIntroduction The provision of high-quality care is vital to improve child health and survival rates. A simple, practice-based tool was recently developed to evaluate the quality of paediatric emergency care in resource-limited settings in Africa. This study used the practice-based tool to describe the documented adherence to critical actions in paediatric emergency care at an urban district-level hospital in South Africa and assess its relation to clinical outcomes. Methods This study is a retrospective observational study covering a 19-month period (September 2017 to March 2019). Patients <13 years old, presenting to the emergency centre with one of six sentinel presentations (seizure, altered mental status, diarrhoea, fever, respiratory distress and polytrauma) were eligible for inclusion. In the patients' files, critical actions specific for each presentation were checked for completion. Post-hoc, a seventh group ‘multiple diagnoses’ was created for patients with more than one sentinel disease. The action completion rate was tested for association with clinical outcomes. Results In total, 388 patients were included (median age 1.1 years, IQR 0.3–3.6). The action completion rate varied from 63% (polytrauma) to 90% (respiratory distress). Participants with ≥75% action completion rate were younger (p < 0.001), presented with high acuity (p < 0.001), were more likely to be admitted (adjusted OR 2.2, 95%CI: 1.2–4.1), and had a hospital stay ≥4 days (adjusted OR 3.4, 95%CI: 1.5–7.9). Conclusion A high completion rate was associated with young age, a high patient acuity, hospital admission, length of hospital stay ≥4 days, and the specific sentinel presentation. Future research should determine whether or not documented care corresponds with the quality of delivered care and the predictive value regarding clinical outcome.https://www.sciencedirect.com/science/article/pii/S2211419X20300987?via%3DihubPublisher’s versio

Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SAgovernment announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes

CHAPTER 9:Microwave Imaging and the Potential of Contrast Enhancing Agents for Theranostics Use

Clinical imaging modalities provide clinical data with a variety of resolutions, clinical implementation costs, and various levels of complexity when applied and interpreted. Imaging techniques that are aimed at molecular imaging require the utilization of ionizing radiation that can pose safety risks and questions related to their frequent use. Microwave sensing and imaging (MSI) is emerging as an alternative method based on nonionizing electromagnetic (EM) signals that lie over a wide frequency range. The main advantages of using EM signals is the low health risk, low cost of implementation, low operational cost, ease of use, and user friendliness. The development of such systems may revolutionise treatments and contribute to advanced safe and cost effective detection and/or treatments. MSI has been used for tumour detection (breast), blood clot/stroke detection, heart imaging, bone imaging, cancer detection, and localization of in-body radio frequency (RF) ablation sources. The introduction of tailor made agents to enhance microwave (MW) dielectric contrast may provide a very useful clinical tool. In MSI applications, nanomaterials that change the dielectric constant when concentrated in tumours could be an elegant solution for tumour detection. MW devices used for sensing can also induce focused and controlled elevation of temperature in tissues (hyperthermia, ablation). This dual operation of MW devices can be combined with smart temperature responsive drug delivery systems to provide integrated tumour therapy and targeted drug delivery systems. The aim of this chapter is to provide an overview of this emerging technique and its potential in diagnostics and therapy.</jats:p

Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital

Introduction: In South Africa’s high injury prevalent setting, it is imperative that injury mortality is kept to a minimum. The CRASH-2 trial showed that Tranexamic acid (TXA) in severe injury reduces mortality. Implementation of this into injury protocols has been slow despite the evidence. The 2013 Western Cape Emergency Medicine Guidelines adopted the use of TXA. This study aims to describe compliance. Methods: A retrospective study of TXA use in adult injury patients presenting to Khayelitsha Hospital was done. A sample of 301 patients was randomly selected from Khayelitsha’s resuscitation database and data were supplemented through chart review. The primary endpoint was compliance with local guidance: systolic blood pressure 110 or a significant risk of haemorrhage. Injury Severity Score (ISS) was used as a proxy for the latter. ISS >16 was interpreted as high risk of haemorrhage and ISS <8 as low risk. Linear regression and Fischer’s Exact test were used to explore assumptions. Results: Overall compliance was 58% (172 of 295). For those without an indication, this was 96% (172 of 180). Of the 115 patients who had an indication, only eight (18%) received the first dose of TXA and none received a follow-up infusion. Compliance with the protocol was significantly better if an indication for TXA did not exist, compared to when one did (p 15 (p < 0.001). Discussion: TXA is not used in accordance with local guidelines. It was as likely not to be used when indicated than when not indicated. Reasons for this are multifactorial and likely include stock levels, lack of administration equipment, time to reach definitive care, poor documentation and hesitancy to use. Further investigation is needed to understand the barriers to administration

Mauvais adhérence aux directives relatives à l’acide tranexamique chez les patients adultes blessés se présentant dans un hôpital de district public sud-africain

CITATION: Wiese, J.G.G. et al. 2017. Poor adherence to Tranexamic acid guidelines for adult, injured patients presenting to a district, public, South African hospital. African Journal of Emergency Medicine, 7(2):63–67. doi:10.1016/j.afjem.2017.04.006.The original publication is available at https://www.afjem.orgIntroduction: In South Africa’s high injury prevalent setting, it is imperative that injury mortality is kept to a minimum. The CRASH-2 trial showed that Tranexamic acid (TXA) in severe injury reduces mortality. Implementation of this into injury protocols has been slow despite the evidence. The 2013 Western Cape Emergency Medicine Guidelines adopted the use of TXA. This study aims to describe compliance. Methods: A retrospective study of TXA use in adult injury patients presenting to Khayelitsha Hospital was done. A sample of 301 patients was randomly selected from Khayelitsha’s resuscitation database and data were supplemented through chart review. The primary endpoint was compliance with local guidance: systolic blood pressure 110 or a significant risk of haemorrhage. Injury Severity Score (ISS) was used as a proxy for the latter. ISS >16 was interpreted as high risk of haemorrhage and ISS <8 as low risk. Linear regression and Fischer’s Exact test were used to explore assumptions. Results: Overall compliance was 58% (172 of 295). For those without an indication, this was 96% (172 of 180). Of the 115 patients who had an indication, only eight (18%) received the first dose of TXA and none received a follow-up infusion. Compliance with the protocol was significantly better if an indication for TXA did not exist, compared to when one did (p < 0.001). Increased TXA use was associated only with ISS >15 (p < 0.001). Discussion: TXA is not used in accordance with local guidelines. It was as likely not to be used when indicated than when not indicated. Reasons for this are multifactorial and likely include stock levels, lack of administration equipment, time to reach definitive care, poor documentation and hesitancy to use. Further investigation is needed to understand the barriers to administration.Introduction: Dans l’environnement sud-africain caractérisé par une forte prévalence de blessures, il est impératif que la mortalité liée aux blessures soit maintenue à un minimum. L’essai CRASH-2 a indiqué que l’acide tranexamique (ATX) réduisait la mortalité en cas de blessures graves. L’adoption de cette procédure dans les protocoles de gestion des blessures a été lente, en dépit des données probantes. Les Directives de médecine d’urgence du Cap occidental 2013 ont adopté l’utilisation de l’ATX. L’étude vise à décrire la conformité. Méthodes: Une étude rétrospective de l’utilisation de l’ATX chez les patients adultes souffrant de blessures et se présentant à l’hôpital de Khayelitsha a été réalisée. Un échantillon de 301 patients a été sélectionné de manière aléatoire dans la base de données de réanimation de Khayelitsha et les données ont été complétées par un examen des dossiers. Le principal paramètre était la conformité aux directives locales: une tension artérielle systolique 110 ou un risque d’hémorragie significatif. L’Indice de gravité des blessures (IGB) a été utilisé à titre d’approximation pour ce dernier. Un IGB >16 a été interprété comme un fort risque d’hémorragie et un IGB <8 comme un faible risque. La régression linéraire et la méthode exacte de Fisher ont été utilisées afin d’étudier les hypothèses. Résultats: Le taux de conformité générale s’élevait à 58% (172 sur 295). Pour ceux ne présentant aucune indication, ce taux s’élevait à 96% (172 sur 180). Sur les 115 patients présentant une indication, seulement huit (18%) avaient reçu la première dose d’ATX et aucun n’avait reçu d’injection subséquente. Le respect du protocole était considérablement meilleur si aucune indication d’ATX n’existait, par rapport à son existence (p 15 (p < 0,001). Discussion: L’ATX n’est pas utilisé conformément aux directives locales. Il était tout aussi susceptible de ne pas être utilisé lorsque cela était indiqué que lorsque cela ne l’était pas. Les raisons en sont multiples et incluent probablement la disponibilité en stock, le manque de matériel d’administration, le temps pour atteindre le lieu de prise en charge définitif, l’absence de documentation et l’hésitation à l’utiliser. Des enquêtes supplémentaires sont nécessaires pour comprendre les barrières à l’administration.Publishers versio

Leadership and early strategic response to the SARS-CoV- 2 pandemic at a COVID-19 designated hospital in South Africa

CITATION: Parker, A. et al. 2020. Leadership and early strategic response to the SARS-CoV- 2 pandemic at a COVID-19 designated hospital in South Africa. South African Medical Journal, 110(6), doi:10.7196/SAMJ.2020v110i6.14809.The original publication is available at http://www.samj.org.zaWhile many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SA government announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes.http://www.samj.org.za/index.php/samj/article/view/12912Publisher's versio