Developing minimum clinical standards for physiotherapy in South African ICUs: A qualitative study

Rationale, aims, and objectives: Physiotherapists are integral members of the intensive care unit (ICU) team. Clinicians working in ICU are dependent on their own experience when making decisions regarding individual patient management thus resulting in variation in clinical practice. No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for ICU physiotherapy. This study explored perceptions of physiotherapists on minimum clinical standards that ICU physiotherapists should adhere to for delivering safe, effective physiotherapy services to critically ill patients. Method: Experienced physiotherapists offering a service to South African ICUs were purposively sampled. Three focus group sessions were held in different parts of the country to ensure national participation. Each was audio recorded. The stimulus question posed was “What is the minimum standard of clinical practice needed by physiotherapists to ensure safe and independent practice in South African ICUs?” Three categories were explored, namely, knowledge, skill, and attributes. Themes and subthemes were developed using the codes identified. An inductive approach to data analysis was used to perform conventional content analysis. Results: Twenty-five physiotherapists participated in 1 of 3 focus group sessions. Mean years of ICU experience was 10.8 years (±7.0; range, 3-33). Three themes emerged from the data namely, integrated medical knowledge, multidisciplinary teamwork, and physiotherapy practice. Integrated medical knowledge related to anatomy and physiology, conditions that patients present with in ICU, the ICU environment, pathology and pathophysiology, and pharmacology. Multidisciplinary teamwork encompassed elements related to communication, continuous professional development, cultural sensitivity, documentation, ethics, professionalism, safety in ICU, and technology. Components related to physiotherapy practice included clinical reasoning, handling skills, interventions, and patient care. Conclusions: The information obtained will be used to inform the development of a list of standards to be presented to the wider national physiotherapy and ICU communities for further consensus-building activities

Variables influencing delay in antenatal clinic attendance among teenagers in Lesotho

A delay in deciding to seek antenatal care is predominant among pregnant teenagers in Lesotho. This subsequently leads to delay in reaching treatment and in receiving adequate treatment. Early antenatal care attendance plays a major role in detecting and treating complications of pregnancy and forms a good basis for appropriate management during delivery and after childbirth. Although antenatal care is provided at different levels, Lesotho still has a high maternal mortality rate, estimated at 762 per 100 000 live births, and an infant mortality rate of 72 per 1 000 live births.1 Lesotho has a chronic shortage of doctors and nurses. According to the Lesotho Population Data Sheet of 2000, the doctor-patient ratio for this country for the year 1999 was 1:13 041 and the nurse ratio was 1:2 035. About 31% of the adult population between the ages of 15 to 49 years is infected with HIV/Aids.1 This shortage of health care personnel and the impact of HIV/Aids result in insufficient focus on health promotion in reproductive health, especially birth preparedness, and lack of community participation and male involvement in reproductive health care issues. Early sexual activities with consequent early pregnancy lead to high maternal and neonatal morbidity and mortality. As a result, the National Adolescent and Development Programme was started in 1998 by the Ministry of Health and Social Welfare to address the needs of teenagers. This led to the establishment of adolescent health clinics (referred to as teenage corners) that focus on teenagers in three districts of Lesotho, namely Mafeteng, Maseru and Leribe. Despite the establishment of these teenage corners, delay in antenatal attendance is still prevalent in Lesotho. Out of 632 pregnant teenagers in 2003 who attended the clinic at Queen II Teenage Corner, the majority (43%) visited the antenatal clinic for the first time during the third trimester and only 14.9% attended in the first trimester. This late antenatal clinic attendance provides little or no time for appropriate screening, management of risk factors, if detected, and timely referral. The aim of this study was to identify variables that contribute to delay in antenatal clinic attendance among pregnant teenagers and to make recommendations based on the research findings for the development of policies that will ensure early attendance. Methods An exploratory, descriptive research design was used to acquire understanding of the variables that contribute to the delay in antenatal clinic attendance among teenagers in Lesotho. The population composed of all pregnant teenagers who have started their antenatal clinic attendance at the three teenage corners after the thirteenth week of gestation. Purposive sampling was used and the sample was considered adequate when saturation of data was reached. A total of 21 pregnant teenagers and 21 parents/guardians participated. Data was gathered through observation of records and activities undertaken at the teenage corners and through in-depth interviews with the teenagers and their parents/guardians. A semi-structured interview schedule was used. Results and conclusions Twenty-one pregnant adolescents were interviewed, of which 71.3% started antenatal clinic attendance during the second trimester, while 28 (57%) started during the third trimester. Variables that contributed to the delay in early antenatal attendance included lack of knowledge regarding the importance of early attendance, denial of the pregnancy by the boyfriend, the fact that sex outside of marriage in Lesotho is still taboo and structural variables related to service provision. The interviews with the pregnant teenagers and their parents/guardians highlighted the need to empower teenagers through education and counselling and the need for the Minister of Education and Training to review policy regarding the expulsion of pregnant teenagers from school. Community awareness campaigns should be held annually to sensitise the public about the increasing rates of teenage pregnancies in Lesotho and the consequences thereof. Life skills education and teenage pregnancy issues should be included in the health courses for primary school learners as early as grade 6 and 7.South African Family Practice Vol. 49 (9) 2007: pp. 1

An immunohistochemical study of various peptide-containing endocrine cells and neurones at the equine ileocaecal junction

The ileocaecal junctions of 5 horses and 2 donkeys were examined by using antisera to the following peptides: somatostatin, glucagon, gastrin, neurotensin, vasoactive intestinal peptide (VIP), peptide histidine isoleucine (PHI), calcitonin gene-related peptide (CGRP), substance P (SP) and neuropeptide Y (NPY). Antisera to somatostatin, neurotensin and NPY demonstrated endocrine cells in the ileal- and caecal parts of the ileocaecal junction, while immunoreactivity for glucagon was demonstrated in endocrine cells of the ileal part only. Nerve cell bodies showing immunoreactivity to SP, VIP, CGRP and PHI were demonstrated in the myenteric and submucosal plexuses and were associated with small blood vessels in the submucosa of all the regions tested. Ramified nerve fibres in the submucosa immunoreactive to SP, VIP, CGRP and PHI extended to the mucosa and to small blood vessels in the submucosa. Nerve fibres showing immunoreactivity to SP, VIP and PHI extended to the circular smooth muscle layer of the ileocaecal junction.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Impact of the Chelsea critical care physical assessment (CPAx) tool on clinical outcomes of surgical and trauma patients in an intensive care unit: An experimental study

Background: Critically ill patients following traumatic injury or major surgery are at risk of loss of skeletal muscle mass, which leads to decreased physical function. Early rehabilitation in an intensive care unit (ICU) is thought to preserve or restore physical functioning. The Chelsea critical care physical assessment (CPAx) is a measurement tool used to assess physical function in the ICU. Objectives: To determine whether the use of the CPAx tool as part of physiotherapy patient assessment, in two adult trauma and surgical ICU settings where early patient mobilisation forms part of standard physiotherapy practice, had an impact on ICU and hospital length of stay (LOS) through delivery of problem-oriented treatment plans. Method: A single-centred pre–post quasi-experimental study was conducted. The population was a consecutive sample of surgical and trauma ICU patients. Participants’ functional ability was assessed with the CPAx tool on alternative days during their ICU stay, and rehabilitation goals were modified according to their CPAx score. Intensive care unit and hospital LOS data were collected and compared to data of a matched historical control group. Descriptive and inferential statistics were used. Results: A total of 26 ICU patients were included in the intervention group (n = 26). They received CPAx-guided therapy, and outcomes were matched with ICU patients in the historical control group (n = 26). The median sequential organ failure assessment (SOFA) score was significantly higher in the control group (p = 0.005) (3.5 [IQR 2–6.3]) versus (2 [IQR 1.8–2.5]) for the intervention group. The median admission CPAx score for the intervention group was 33.5 (IQR 16.1–44), and the median ICU discharge score was 38 (IQR 28.5–43.8). No significant differences were found in ICU days (control 2.7 [IQR 1.1–5.2]; intervention 3.7 [IQR 2.3–5.4]; p = 0.27) or hospital LOS (control 13.5 [IQR 9.3–18.3]; intervention 11.4 [IQR 8.4–20.3], p = 0.42). Chelsea critical care physical assessment scores on ICU admission had a moderate negative correlation with hospital LOS (r = -0.58, p = 0.00, n = 23). Chelsea critical care physical assessment scores at ICU discharge had strong positive correlation with discharge SOFA scores (r = 0.7; p = 0.025; n = 10). Conclusion: Problem-oriented patient rehabilitation informed by the CPAx tool resulted in improvement of physical function but did not reduce ICU or hospital LOS. Clinical implications: A higher level of physical function at ICU admission, measured with CPAx, was associated with shorter hospital LOS.South African Society of Physiotherapy Research Foundatio

A comparison of the clinical relevance of thallium201 and technetium-99m-methoxyisobutyl-isonitrile for the evaluation of myocardial blood flow

Thallium-201 is at present the radiotracer of choice for the clinical evaluation of myocardial blood flow. Although different technetium-99m-isonitrile agents have been synthesised recently, only 99mTc-melhoxyisobutyl-isonitrile (99mTc_MIBI) has proved to hold promise for clinical implementation. The myocardial distribution of 201TI and 99mTc_MIBI was compared in a group of 20 patients, who underwent both 201TI single photon emission computed tomography and 99mTc_MIBI study as well as coronary angiography. The sensitivity for predicting a lesion ranged from 25% to 88% in different areas of the heart and was comparable for the two radiophannaceuticals. The specificity was > 80% tor all regions except the inferior region where a specificily ot 58% obtained by 99mTc-MIBI was better than the low specificity of 17% obtained with 201TI (P< 0,008)

A light microscopical study of the intestinal tract of the Nile crocodile (Crocodylus niloticus, Laurenti 1768)

Although the histology of the intestinal tract of Crocodylus niloticus is touched on in overall studies on reptilian intestinal tract, a more comprehensive light microscopical study on this area is lacking. Specimens for histological examination were taken from the duodenum, the jejunum, the ileum and the rectum. The data obtained revealed that the mucosa is thrown into folds and simple, slightly branched tubular intestinal glands. The mucosal folds diminished in height and eventually disappeared upon reaching the ileorectal junction. The epithelium covering the folds and crypts was of the simple columnar type. Clear marginal cells, goblet cells and argentaffin cells were observed throughout the intestinal tract. No Paneth cells were seen in this study. The lamina propria was rich in lymphocytic infiltrations while the muscularis mucosa consisted mainly of an outer longitudinal layer, the inner circular layer being rudimentary or absent. The submucosa was extremely narrow, and the circular and longitudinal layers of the tunica muscularis contained distinct layers of dense fibrous connective tissue. The histology of the intestinal tract of C. niloticus is shown to be in line with the situation in crocodilians and also exhibits a resemblance to that of carnivorous mammals.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Bioactive peptides and serotonin, in the gut endocrine cells of the crocodile, Crocodylus niloticus (Laurenti 1768) : an immunocytochemical study

Little is known about peptide-storing endocrine cells in the gut of the Nile crocodile. As in the case of other reptiles, particularly the alligator, a limited range of peptide-storing cells was found in the gut of the crocodile. They were somatostatin, glucagon, gastrin, neurotensin and pancreatic polypeptide. The topographical distribution of cells immunoreactive to somatostatin and gastrin in the gut of the crocodile is comparable to the situation in the alligator. Glucagon and neurotensin immunoreactive cells have a much wider distribution in the gastrointestinal tract of the crocodile compared to the alligator. Cholecystokinin and bombesin cells previously reported in the small intestine of the alligator were not detected in this study. This is the first report to demonstrate pancreatic polypeptide and serotonin immunoreactivity in the gut of a crocodilian specie.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Exercise testing of patients after a period of prolonged mechanical ventilation

In this study, physical recovery of patients who received prolonged mechanical ventilation (PMV) was assessed with a six-phase functional exercise test after the period of ventilation. A prospective correlation study using a consecutive sampling method was carried out over a six-month period. Thirty-one patients were tested but five were lost to follow-up Statistical tests included the Pearson’s correlation coefficient, student’s paired t-test and Kaplan-Meier survival estimate. Subjective perceived effort changed significantly from phase to phase in the exercise test and over time (p < 0.00) Heart rate and respiratory rate responses indicated increased cardio-respiratory effort during the test. No correlation existed between subjective perceive

Determination of glomerular filtration rate with radionuclide renography and direct urinary activity quantitation

Objective. The direct urinary activity quantitation method is quick (approximately 40 minutes), requires only a single blood sample, is performed as part of standard renal scanning and shows high accuracy compared With 24hour creatinine clearance. The purpose was to evaluate the practical application and accuracy of this technique at our clinic. Design. Direct urinary activity quantitation was done in patients scheduled for routine radionuclide renography and compared to standard multiple-blood-sample techniques by means of Cr-51-EDTA and Tc-99m-DTPA.Setting. Academic Medical Complex, Department of Nuclear Medicine, Universitas Hospital, Bloemfontein.Participants. Fifteen patients scheduled for routine radionuclide renography (glomerular filtration rate (GFR) determination) were voluntarily enrolled in the study. The GFRs of selected patients varied over a wide range. Possible obstructive uropathy was excluded.Main outcome measures. GFRs obtained by the direct urinary method were compared with GFRs determined by multisample Cr-51-EDTA and Tc-99m DTPA.Results. GFRs from the direct urinary method compared with multisample Tc-99m-DTPA showed differences from -19,85 to 22,95 ml/min with a mean of 0,2 (+- 12,25) ml/min (r = 0,93). When compared with multisample Cr-51 EDTA, differences ranged from -34,35 to 21,05 ml/min with a mean of -4,25 (+- 16,08) ml/min (r =0,90).Conclusion. The direct urinary activity technique is easily applied and highly accurate compared with previous standardised multisample radionuclide techniques for determination of GFR

Back-carrying in children is related to lower limb development

Back-carrying of children is a culturally accepted method of transport and safekeeping of babies in many cultures. Developmental consequences related to back-carrying practices have not been directly investigated. This study determined the relationship between frontal and transverse plane lower limb (LL) development, and back-carrying practices, in black Setswana-speaking children. In 691 2- to 9-year-old Setswana-speaking children, the tibiofemoral angle, intermalleolar distance, femoral anteversion angle (AVA) and tibial torsion angle (TTA), were measured to determine LL development. Back-carrying practices were recorded with a questionnaire and Classification and Regression Tree (CART) was used for the analyses. Significant (p < 0.001) relationships, between back-carrying practices and LL development, were discovered. Statistically significant greater genu valgum (F(5, 690) = 7.2, p < 0.001), greater internal TTAs (F(9, 684) = 17.8, p < 0.001), and smaller AVAs (F(13, 685) = 5.1, p < 0.001) were observed in children back-carried more frequently than children back-carried less frequently. There are relationships between back-carrying practices and LL development in both the frontal and transverse plane. However, the genu valgum, internal TTA and smaller AVA noted in more frequently back-carried children is still within normal limits, thus no educational intervention in back-carrying methods or durations is required. Further research should determine the exact back-carrying practice factors (age until which the child is back-carried) impacting lower limb development the greatest.This is a part of the Ph.D. thesis of Mariaan van Aswegen at North-West University, Potchefstroom 2520, South Africa.https://www.mdpi.com/journal/childrendm2022Consumer ScienceFood Scienc