South African Paediatric Surgical Outcomes Study : a 14-day prospective, observational cohort study of paediatric surgical patients

BACKGROUND : Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS : We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS : We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS : The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION : NCT03367832.Jan Pretorius Research Fund; Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town; Department of Anaesthesia, University of the Witwatersrand; and the Paediatric Anaesthesia Community of South Africa (PACSA).https://bjanaesthesia.org2020-02-01gl2019Anaesthesiolog

Strategies for Managing a Virtual Workforce

Journal articles of The 7th Annual International Conference on Public Administration and Development Alternatives, 14 - 16 September 2022In today's fast-paced, ever-changing organizational environment, there is a heightened need for versatility and productivity in every situation. With the advance in technology and changing customer needs, an organization can find itself left behind the competition if it does not work smarter and faster than others in the marketplace. To keep up with these demands, many organizations have had to do away with the concept of traditional, on-site, office environments for those of virtual configuration, especially now during this COVID-19 pandemic as this allows companies to operate with lower overhead costs, capitalize on geographically dispersed talent and provide flexibility in the services they offer. This has since been a challenge to managers as they cannot have face-to-face interactions and have had to come up with new management styles to make sure the virtual workforce is performing and producing as per organisational standards

Human Resource Management Practices Amid COVID-19 Crisis: A Case of Botswana Public Service

Journal articles of the 7th Annual International Conference on Public Administration and Development Alternatives, 14 - 16 September 2022 1This paper seeks to study the challenges of public sector human resource management during the COVID-19 pandemic, and the resultant opportunities as well as the implications these have on the directions of the organisations post pandemic. A desk top research was used, and data collection was carried out in different sources exploring the impact of the COVID-19 on human resource management. Organizations had to adapt very fast to disruptions caused by the advent of the COVID-19 pandemic in both the internal and external environment of organisations. That resulted in uncertainties amongst the workforce and posed immediate threats to organizations' performances and productivity while at the same time disrupting strategies, employee relations, staffing occupational health, training and career development, compensation management. However, organizations had to navigate through the unprecedented times and thereby find new solutions to challenges across the stated areas of the operations. This paper will unravel how most of the solutions became trends of the COVID-19 era for and glimpse how these HR trends will continue to drive transformation and which new trends are emerging to shape the future of work

The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study

BACKGROUND : The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs). AIM : The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion. METHOD : This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted. RESULTS : There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion. CONCLUSION : Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.http://wileyonlinelibrary.com/journal/panhj2021Anaesthesiolog