An evaluation of the Triage Early Warning Score in an urban accident and emergency department in KwaZulu-Natal

Objective: Triage is an essential first step in the efficient and effective running of any emergency department. A good triage tool saves lives and reduces mortality. The Triage Early Warning Score (TEWS) is a useful tool used to identify patients in emergency departments who are at risk of deterioration and who may require admission. As this triage tool has only been evaluated to a limited extent, this study assessed its effectiveness in identifying patients at risk of early deterioration to enable timely medical intervention.Design and setting: This was a retrospective study of medical records within the accident and emergency department of an urban public hospital.Outcome measures: The calculated TEWS was compared to one of four possible outcomes viz. discharge within 24 hours, admission to the ward, admission to the intensive care unit (ICU), or death in hospital. Pearsonfs chi-squared tests and cross-tabulation was used to determine the statistical significance of the association.Results: Of the 265 patient records analysed, 233 (87.9%) had a TEWS of < 7. Of patients with a TEWS of < 7, 53.7% were discharged, compared to 18.7% with a score . 7, who were discharged. The average score of the four patients who died was 9.5, and 8.2 for the three admitted to ICU. Higher TEWS were significantly associated with increased admission to hospital and in-hospital deaths (p-value 0.032).Conclusion: An effective triage scoring system ensures that those requiring emergency care are appropriately categorised. Prompt intervention will either reverse further physiological decline or facilitate timely referral to the appropriate service level, including ICU

Management of upper gastrointestinal bleeding

This paper will describe the common symptoms, signs and causes of upper gastrointestinal bleeding. We will then provide advice on the management of upper gastrointestinal bleeding at primary care level.http://www.safpj.co.za/index.php/safpjhttp://www.tandfonline.com/loi/ojfp20am2020Family Medicin

An overview of Pneumocystis jirovecii pneumonia for the African generalist practitioner

Introduction: Pneumocystis jirovecii is the causative organism of Pneumocystis pneumonia (PCP) in humans, which is more common among immunocompromised patients. Classically patients present with fever, non-productive cough, and dyspnoea. In the HIV-infected individuals the symptoms may be subtle at first, but gradually progress over several weeks. In the HIV-uninfected patient, however, the duration of symptoms is shorter and more severe, mainly due to the increased inflammatory response of the HIV-uninfected patient. Methods: This article focuses on the diagnostic methods and then the management and prophylaxis principles of PCP by reviewing the best current practices and guidelines in Africa. Conclusion: This overview is presented by clinicians who have experience with PCP and is directed mainly at first-line healthcare providers

Development of Advanced Traffic Flow Models and Implementation in Parallel Processing, Phase II (9/15/92-9/15/93)

In this report, five high-order continuum traffic flow models are compared: Payne's model; Papageorgiou's model; the semi-viscous model and the viscous model as well as a proposed high-order model, and the simple continuum model. The stability of the high-order models is analyzed and the shock structure investigated in all models. In addition, the importance of the proper choice of finite-difference method is addressed. For this reason, three explicit finite-difference methods for numerical implementation, namely, the Lax method, the explicit Euler method and the upwind scheme with flux vector splitting, are discussed. The test with hypothetical data and the comparison of numerical results with field data suggest that high-order models implemented through the upwind method are better than the simple continuum model. The proposed high-order model appears to be more accurate than the other high-order models

Profile of adult patients admitted with drug-induced liver injury at a district hospital in Pietermaritzburg, KwaZulu-Natal

Background: Drug-induced liver injury (DILI) can be prevented if diagnosed and treated timeously. The identification and primary prevention of DILI risk factors presents the rational means of reducing hospital costs and mortality.Methods: A retrospective chart review was conducted of clinical in-patient records of all adult patients admitted to Northdale Hospital (NDH) with a diagnosis of DILI. Patients with pre-existing liver disease were excluded.Results: A total of 95 patient files with DILI were reviewed. The burden of DILI at NDH over the two-year period was 0.19%. The average age was 38 years, with a slightly higher female preponderance (62.1%). A lower serum albumin level (mean 21.35 g/dl) was significantly associated with DILI (p 0.001). Forty-six patients had a history of alcohol consumption, which increased the risk of DILI (OR 2.1). Of the patients reviewed, 62 (65%) were on antiretroviral therapy (ART) whereas 41 (43%) were on tuberculosis treatment (TBT) at presentation. The most common co-morbidities associated with DILI were HIV (75.7%), TB (43.2%), renal disease (34.7%) and malnutrition (31.6%). The most common hepatotoxins, apart from ART and TBT, were paracetamol (46.3%), cotrimoxazole (32.6%), alcohol (48.4%) and traditional medication (27.4%).Conclusion: This study demonstrated associations with the development of DILI and being female gender, younger age group, hypoalbuminaemia and renal failure. The use of alcohol, traditional medication and the overzealous use and prescription of paracetamol to patients who present with DILI is concerning. The case fatality rate of 14.7% demonstrates the importance of identifying these potential risk factors timeously

Susceptibility to hepatitis B infection, hepatitis B/HIV co-infections and hepatitis B immunity in HIV-positive patients starting HAART in Durban, South Africa

Background: HIV/HBV co-infection remains a global threat to HIV management despite the available effective hepatitis B vaccine and hepatitis B covering antiretroviral therapy. Many studies done in South Africa and internationally showed high prevalence of HIV/hepatitis B co-infection, which mandated routine screening for both infections before initiating HAART. Fewer studies have highlighted the prevalence of hepatitis B susceptibility in the general population starting HAART and most of them were limited to children and high-risk groups. The aim of this study was to demonstrate the extent of hepatitis B susceptibility, hepatitis B/HIV co-infections and hepatitis B immunity in general HIV-infected patients.Method: This was a retrospective review of 1 066 randomly sampled files of patients initiated on HAART between January 2012 and December 2014 at two Durban hospitals. Data collection included demographic characteristic, CD4 counts and hepatitis B serology. Data were analysed for the prevalence of hepatitis B susceptibility, HIV/HBV co-infection and hepatitis B immunity, while correlations between age, CD4 count and these three groups were demonstrated. Statistical analysis was performed using SAS version 9.3.Results: Total prevalence of HBV susceptibility was 69.7%, HBV immunity was 26.9% and true chronic HIV/HBV co-infection was 3.4%, while HBVsAg positivity accounted for 8.4% of the participants. Adults were more susceptible to HBV than children, with a median age of 36 years. Stratified for age, children were more immune (90%) to HBV than adults.Conclusion: This study demonstrated a significantly high number of HIV-infected persons who were susceptible to hepatitis B infection in Durban, South Africa, where both HIV and HBV are endemic, co-infection is high, and safe and effective HBV vaccine is available. Hepatitis B vaccination of the hepatitis B susceptible patients initiating HAART in South Africa is recommended to prevent further HIV/HBV co-infection

Compliance with local diabetic guidelines at a district hospital in KwaZulu-Natal, South Africa

Background: Diabetes mellitus (DM) represents a major health-related problem in South Africa and throughout the world. The management goals of diabetes are first to maintain normal blood glucose levels and second to prevent the development of complications. Local guidelines developed by the Society for Endocrine Metabolism and Diabetes South Africa (SEMDSA) have shown that tight glycaemic control and appropriate monitoring can prevent or delay the development of diabetic complications. The demographic profile of patients with type 2 DM and the compliance of doctors to the guidelines were determined.Methods: Five hundred records of patients with type 2 DM were selected from the medical outpatients’ department (MOPD) by systematic sampling. Demographic information on age, sex and ethnicity was obtained. The performance and timing of recommended investigations were recorded and compared with the 2012 SEMDSA guidelines.Results: The mean age of patients was 61 years. Black and Indian patients formed the majority, comprising 44.4% and 43.0% respectively. Glycated haemoglobin was measured in 29.2% of patients once and 13.2% of patients twice in the past year. Lipid studies were done on 40.4% of patients. A serum creatinine (sCr), estimated glomerular filtration rate (eGFR) and serum potassium were done on 38.2% of patients. Eye examinations were done on 13.60% patients and examination of the foot was done on 7.8% of patients. Some 15% had a urine dipstick test done at least once in the past year and 10.4% had a urine albumin/creatinine ratio (ACR) requested. Only 21 patients (4.2%) were compliant with the SEMDSA guidelines. Measurements of blood pressure and blood glucose were 100% compliant. Anthropometric measurements (height, weight and body mass index), dietitian referral and foot examinations were the least compliant, being performed 4.2%, 5.0% and 7.8% of the time respectively.Conclusion: Black and Indian patients formed the majority of the study population. The screening for chronic complications of type 2 DM was poor in the majority of patients. Evaluation of selected records demonstrated compliance with the SEMDSA guidelines in only 4.2% of patients. There is an urgent need to review barriers to the implementation of guidelines in South Africa

Management of the patient with chronic obstructive airway disease (COPD) in a primary health care context

This paper describes the incidence of chronic obstructive airway disease (COPD), the risk factors, staging, investigations and management of COPD. The differential diagnosis for COPD is also presented as COPD can be confused with other clinical conditions. This paper is presented in practical terms for the clinician working in a primary health care context

Original live music venues in hyper-commercialised nightlife precincts: exploring how venue owners and managers navigate cultural, commercial and regulatory forces

Nightlife precincts are constituted by intersecting cultural, market and regulatory forces. They are a vibrant part of the experience economy of the city and important sites for the performance of live music and arts. This article examines original live music venues in Fortitude Valley, an inner-city neighbourhood in Brisbane, Australia. The Valley is both a culturally significant site for original live music venues and a dense hyper-commercialised nightlife precinct. Policy interventions in the area have sought to protect its live music venues, liberalise its nightlife economy, and curtail the harms generated by alcohol consumption. Drawing on interviews with live music venue owners and managers we argue that over time venues have adapted their ethos to the cultural and market logic of the nightlife precinct, rather than the music scene. Their accounts illustrate that venues are an important site where cultural values and market imperatives are negotiated