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

Tuberculosis in medical doctors – a study of personal experiences and attitudes

Background. The concurrent TB and HIV epidemics in sub-Saharan Africa place all healthcare workers (HCWs) at increased risk of exposure to Mycobacterium tuberculosis.Aim. This study explores personal experiences, attitudes and perceptions of medical doctors following treatment for TB within the healthcare system.Method. Sixty-two medical doctors who were diagnosed with and treated for TB during 2007 - 2009 agreed to participate and complete a semi-structured questionnaire.Results. The response rate was 64.5% (N=40). The mean age of participants was 33.7 years (standard deviation ±10.6). A correct diagnosisof TB was made within 7 days of clinical presentation in 20% of  participants, and was delayed beyond 3 weeks in 52.5%. Non-routinespecial investigations and procedures were performed in 26 participants. Complications following invasive procedures were reported by 8 participants. Multi-drug resistant TB (MDR-TB) was diagnosed in 4 participants. Nineteen considered defaulting on their treatment because of drug side-effects. The majority (n=36) expressed concerns regarding lack of infection control at the workplace, delays in TB diagnosis and negative attitudes of senior medical colleagues and administrators. Ninety per cent of participants indicated that their personal illness experiences had positively changed their professional approach to patients in their current practice.Conclusion. The inappropriate delays in diagnosis in a large number of participants, coupled with a number of negative personal perceptions towards their treatment, are cause for concern. The results further amplify the need for improved educational and awareness programmes among all healthcare personnel (including hospital administrators), adherence to national health guidelines, effective infection control measures, pre- and post-employment screening in all HCWs, and changes in attitudes on the part of senior medical colleagues and administrators

Communication Skills as a Subject in the Programme Cost and Management Accounting at a South African University

The purpose of this paper is to evaluate the communication proficiency of the Cost and Management (CMA) students and to assess whether the studying of the subject,, â€Communication Skillsâ€, is having any positive influence on students’ skills development. The research design for this paper was descriptive, quantitative and cross-sectional. The target population was 556 CMA students. A census survey was conducted. Findings, which were analysed with the aid of descriptive statistics, indicate a significant correlation between skills in English proficiency and better grades in CMA. This paper recommends the implementation of a screening mechanism and the provision for the acquisition of communication skills for first-year university students

The impact of general education in enhancing the self-efficacy of accounting students at universities of technology

The aim of this article is to investigate the integration of General Education in improving the Self-efficacy of Cost and Management Accounting (CMA) students to assess whether Self-efficacy, is having any positive impact on the students’ academic performance. The research design of this article was descriptive, longitudinal and employed a mixed-method approach. The nature of the quasi-experimental approach that was used in the current article is a non-equivalent pre-test and post-test control group design. The target population was CMA students. A census survey was performed. Findings, which were analysed with the aid of descriptive statistics, indicate a significant correlation in the post-test (Self-efficacy) scores of the group that undertook the General Education Modules and not the group that did not undertake the General Education Modules. This article recommends the implementation of General Education skills into the curriculum and a General Education intervention strategy. Moreover, these skills appear to be very poor amongst current learners and respondents believed that Self-efficacy could have a positive effect on the academic performance of learners. &nbsp

Drugs and the kidney

This article on drug nephrotoxicity is detailed, as it is important to be fully aware of renal side effects of drugs with regard to prevention and early diagnosis in order to manage the condition correctly. Many therapeutic agents are nephrotoxic, particularly when the serum half-life is prolonged and blood levels are raised because of decreased renal excretion. Distal nephrotoxicity is markedly enhanced when the glomerular filtration rate (GFR) is reduced and is a particular threat in elderly patients with so called ‘normal’ creatinine levels. In patients of 45 - 55 years of age the GFR is reduced by about 1 mL/min/year, so that an otherwise healthy person of 80 may have an estimated GFR (eGFR) of <60 mL/min or <50 mL/min, i.e. stage 2, 3 or 3b chronic kidney disease (CKD). Furthermore, other effects related to kidney dysfunction may be seen, e.g. worsening of hypertension with the use of non-steroidal anti inflammatory drugs, increased bruising or bleeding tendency with aspirin, and hyponatraemia hypertension acidosis with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Digoxin is contraindicated in stage 3 CKD, even in a reduced dosage. Other drugs can cause the direct formation of kidney stones, e.g. topiramate (used in the prophylaxis of resistant migraine). Levofloxacin (Tavanic) can cause rupture of the Achilles tendon and other tendons.Radiocontrast media must be used with care. Occasionally, strategies to prevent acute kidney insufficiency cause irreversible CKD, especially in patients with diabetes and those with myeloma who have stage 4 - 5 CKD. Gadolinium in its many forms (even the newer products) used as contrast medium for magnetic resonance imaging is best avoided in patients with stages 4 and 5 CKD

Prevalence of mental disorders in a prison population in Durban, South Africa

Objective: The aim of this study was to determine the prevalence of serious mental disorders in a prison population in Durban, South Africa, one of the largest prisons in the Southern hemisphere. Method: 193 prisoners were interviewed using the Mini Neuro-psychiatric Interview, a screening questionnaire and a demographic questionnaire. Results: The study demonstrated that 55.4% of prisoners had an Axis 1 disorder. The commonest disorder being substance and alcohol use disorders ( 42.0%). 23.3% of prisoners were diagnosed with current psychotic, bipolar, depressive and anxiety disorders. 46.1% were diagnosed with antisocial personality disorder. The majority of prisoners diagnosed as having an Axis 1 disorder in this study, were neither diagnosed nor treated in prison. Conclusion: There is a high prevalence of mental disorders among prisoners in a prison population in Durban, South Africa. The majority of these prisoners are untreated in prison, related to non detection of the mental disorder. Greater mental health awareness and provision of mental health services focusing on staff training programmes to detect mental illnesses are needed and further research is recommended throughout South Africa.Keywords: Prevalence; Mental disorders; Prison population; South Afric

Pattern of dyslipidaemia in relation to statin use in patients with type 2 diabetes mellitus attending a tertiary care hospital

Introduction: Atherosclerotic cardiovascular disease is a major contributor to morbidity and mortality in diabetic patients. Strict goal-directed lipid control in patients with diabetes is associated with better cardiovascular outcomes.Aim: The main aim of this study is to describe the lipid profiles of a cohort of patients with type 2 diabetes mellitus in order to highlight the quality of lipid control by correlating the type and dose of lipid-modifying therapy used with lipid levels.Method: A retrospective analysis was performed on 200 type 2 diabetic patients who attended the Charlotte Maxeke Johannesburg Academic Hospital diabetic clinic. Their lipid profiles and the type and dose of lipid-modifying therapy prescribed was assessed.Results: Although the majority of participants (146 [73%]) were at the ideal level for total cholesterol, fewer (133 [66.5%]) were at the ideal level for triglycerides and 112 (56%) participants were at the ideal level for HDL cholesterol, only 53 (26.5%) participants were at target for LDL cholesterol, and very few, only 25 (12.5%), participants were at target for all four lipid parameters.Conclusion: Higher doses of statins or the use of more potent statins with or without the addition of other lipid modifying drugs is  recommended in order to achieve LDL cholesterol target in the majority of patients with type 2 diabetes

Chronic kidney disease and cardiovascular disease

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