4 research outputs found

    A descriptive survey of the nursing workforce in critical care unit in hospitals of the Western Cape Province

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    Includes bibliographical references (leaves 113-121).A global shortage of Registered Nurses (RNs) has been reported internationally, and confirmed in South Africa by the National Audit of Critical Care services. Critical Care Nurses (CCNs) especially are in great demand and short supply. This has affected the quality of patient care. The purpose of this study was to perform a workforce analysis and needs assessment of critical care nursing services in the Western Cape Province as at 1 January 2005. The study design is a descriptive survey conducted on site in the critical care units of the private and public sector hospitals of the Western Cape, using a structured questionnaire, with a 96.5% return rate. Findings showed that the 35 hospitals surveyed in the public and private healthcare sectors had 80 functional critical care units including Intensive Care Units and High Care Units for adults, children and neonates, and High Dependency Units for adults. Factors that contribute to the demand for critical care nurses include the number of critical care beds, patient admissions, severity of illness, available facilities, medical, nursing and support staff. Compared to internationally accepted norms, the Western Cape units have a deficit of 74% of Registered Nurses (RNs) in the public sector hospitals, and a deficit of 82% in the private sector. This equates to an actual shortage of 3010 RNs for both sectors. If all categories of nursing staff are included in the calculation, the public sector meets 49% of its requirements and the private sector 24%. Half of the private sector and 28.9% of the public sector Registered Nurses are Critical Care Nurses. Few measures appear to be taken to recruit and retain nursing staff. The number of students being trained at both the undergraduate (300 during 2004) and the postgraduate (80 CCNs during 2004) level at the educational institutions, in conjunction with the hospitals, is inadequate. Clinical training institutions are available, but the numbers of educators and clinical mentors are inadequate to train the number of nurses required to meet the demand

    Obstructive pulmonary disease in patients with previous tuberculosis: Pathophysiology of a community-based cohort

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    Background. An association between chronic airflow limitation (CAL) and a history of pulmonary tuberculosis (PTB) has been confirmed in epidemiological studies, but the mechanisms responsible for this association are unclear. It is debated whether CAL in this context should be viewed as chronic obstructive pulmonary disease (COPD) or a separate phenotype. Objective. To compare lung physiology and high-resolution computed tomography (HRCT) findings in subjects with CAL and evidence of previous (healed) PTB with those in subjects with smoking-related COPD without evidence of previous PTB. Methods. Subjects with CAL identified during a Burden of Obstructive Lung Disease (BOLD) study performed in South Africa were studied. Investigations included questionnaires, lung physiology (spirometry, body plethysmography and diffusing capacity) and quantitative HRCT scans to assess bronchial anatomy and the presence of emphysema (–200 HU). Findings in subjects with a past history and/or HRCT evidence of PTB were compared with those in subjects without these features. Results. One hundred and seven of 196 eligible subjects (54.6%) were enrolled, 104 performed physiology tests and 94 had an HRCT scan. Based on history and HRCT findings, subjects were categorised as no previous PTB (NPTB, n=31), probable previous PTB (n=33) or definite previous PTB (DPTB, n=39). Subjects with DPTB had a lower diffusing capacity (Δ=–17.7%; p=0.001) and inspiratory capacity (Δ=–21.5%; p=0.001) than NPTB subjects, and higher gas-trapping and fibrosis but not emphysema scores (Δ=+6.2% (p=0.021), +0.36% (p=0.017) and +3.5% (p=0.098), respectively). Conclusions. The mechanisms of CAL associated with previous PTB appear to differ from those in the more common smoking-related COPD and warrant further study..info:eu-repo/semantics/publishedVersio

    Obstructive pulmonary disease in patients with previous tuberculosis: Pathophysiology of a community-based cohort

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    Background. An association between chronic airflow limitation (CAL) and a history of pulmonary tuberculosis (PTB) has been confirmed in epidemiological studies, but the mechanisms responsible for this association are unclear. It is debated whether CAL in this context should be viewed as chronic obstructive pulmonary disease (COPD) or a separate phenotype.Objective. To compare lung physiology and high-resolution computed tomography (HRCT) findings in subjects with CAL and evidence of previous (healed) PTB with those in subjects with smoking-related COPD without evidence of previous PTB.Methods. Subjects with CAL identified during a Burden of Obstructive Lung Disease (BOLD) study performed in South Africa were studied. Investigations included questionnaires, lung physiology (spirometry, body plethysmography and diffusing capacity) and quantitative HRCT scans to assess bronchial anatomy and the presence of emphysema (<–950 HU), gas trapping (<–860 HU) and fibrosis (>–200 HU). Findings in subjects with a past history and/or HRCT evidence of PTB were compared with those in subjects without these features.Results. One hundred and seven of 196 eligible subjects (54.6%) were enrolled, 104 performed physiology tests and 94 had an HRCT scan. Based on history and HRCT findings, subjects were categorised as no previous PTB (NPTB, n=31), probable previous PTB (n=33) or definite previous PTB (DPTB, n=39). Subjects with DPTB had a lower diffusing capacity (Δ=–17.7%; p=0.001) and inspiratory capacity (Δ=–21.5%; p=0.001) than NPTB subjects, and higher gas-trapping and fibrosis but not emphysema scores (Δ=+6.2% (p=0.021), +0.36% (p=0.017) and +3.5% (p=0.098), respectively).Conclusions. The mechanisms of CAL associated with previous PTB appear to differ from those in the more common smoking-related COPD and warrant further study
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