The perceived impact of a global pandemic on a provincial department’s organisational structure

Orientation: Several existing studies examine the effect organisational structures have on businesses, but there is limited research that considers the effects unforeseen crises have on organisational structures. Research purpose: The study sought to determine the effects that the coronavirus disease 2019 (COVID-19) pandemic and lockdown had on the organisational structure of a provincial health department, specifically relating to performance management, employee productivity and organisational citizenship behaviour. Motivation for the study: Additional pressure on health workers, who were seen as ‘essential workers’ during the pandemic, motivated the investigation of how organisational structure affects employees’ ability to perform their duties during crises. Research approach/design and method: The study employed a quantitative research approach, using surveys. A non-experimental research method and convenience sampling were employed and a sample of 207 respondents (n = 207) was achieved. Main findings: The respondents agreed that the pandemic did not cause a decline in their performance due to effective workload management. They also agreed that they still felt passionate about their work during the pandemic. They further posited that the pandemic emphasised the importance of teamwork. Practical/managerial implications: The study offers insights into some factors that produced successful outcomes when handling the pandemic, which can inform organisational strategy during any similar future crises. Contribution/value-add: The study adds to the limited literature linking human resources management and change or crisis management, which is critical when navigating a rapidly changing present and an increasingly uncertain workplace future

Comparing the effectiveness of phenylephrine infusion versus bolus regimen intreating hypotension during caesarean delivery under spinal anaesthesia

Background: Phenylephrine is a preferred drug in preventing and treating hypotension during spinal anaesthesia for Caesarean section. Different techniques may be used to administer to get optimal blood pressure control.Objective: To compare an infusion technique (group A) against a bolus regimen (group B) in maintaining blood pressure closer to baseline values in patients undergoing Caesarean section under spinal anaesthesia.Patients and Methods: 96 patients were randomised to group Aand Bin a case-control study. The infusion was started at 100μg/minute immediately after administering spinal anaesthetic in Group A, and was maintained unless the patient developed hypertension (20% above baseline). In Group B, a 100μg bolus was given immediately after administration of spinal anaesthesia and additional 100μg boluses if hypotension occurred (20% below baseline). The primary outcome measure was degree of change in blood pressure from baseline level measured in mmHg.Results: The infusion group had mean change in BPof +1.65mmHg (SD = ±6.88) and the bolus group had mean change in BP of -10.77mmHg (SD = ±9.16). There was a significant difference in mean blood pressure changes (p<0.01) between the groups. The infusion group had less incidences of hypotension (p< 0.05). Reactive hypertension and bradycardia were noted in Group Abut not in group B. The blood pressure was maintained within 20% of baseline using either technique of phenylephrine administration.Conclusion: Phenylephrine infusion maintains BP closer to baseline with less hypotension, nausea and vomiting compared to bolus technique. However infusions at 100μg/minute may cause reactive hypertension and bradycardia.Keywords: hypotension, caesarean section, spinal anaesthesia, phenylephren

Is oxygen supplementation necessary for patients under spinal anaesthesia? - A prospective hospital- based study

Background: Oxygen supplementation is given routinely to patients undergoing surgery under spinal anaesthesia, the basic aim being to prevent oxygen desaturation and hypoxemia.Objective: This study aimed to find out the incidence of hypoxemia under spinal anaesthesia and determine if oxygen supplementation is necessary for patients under spinal anaesthesia.Materials and methods: This was a prospective nonrandomised study, conducted at a central hospital in Zimbabwe: Parirenyatwa Group of Hospitals, Harare. Fifty- nine (59) consenting patients, both sexes, ASA I-IV undergoing surgery under spinal anaesthesia with standard doses of heavy bupivacaine and fentanyl were recruited. Oxygen saturation was measured before the spinal anaesthetic and continuously after the spinal anaesthetic up to the recovery room, until discharge to the ward using a Datex Ohmeda pulse oximeter. Rescue oxygen supplementation was given to patients that became hypoxemic (SPO2< 90% for >30 seconds with a normal wave form on plethysmogragh).Results: The incidence of intra operative hypoxemia under spinal anaesthesia in this study was 1.69%, and there was a relationship between height of block and saturation change.Conclusion: From the study, it is concluded that it is not necessary to routinely supplement oxygen to patients under spinal anaesthesia

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa