Emergency care research priorities in South Africa

Background: Emergency care research is rarely undertaken in low- and middle-income countries. A manageable ‘road map’ for research in South African (SA) emergency care is needed to address research gaps.Objective: To identify, collate and prioritise research topics from identified knowledge gaps in emergency care in SA.Methods: Seventy-six individuals were invited to participate in a modified Delphi study. Participants were requested to suggest important research topics before rating them. Consensus was achieved when >75% of participants strongly agreed or disagreed. Participants then ranked the agreed statements before selecting the most appropriate methodology relating to study design, funding and collaboration.Results: Three hundred and fifty topics were suggested by 31 participants. Topics were collated into 123 statements before participants rated them. Consensus was achieved for 39 statements. The highest-ranked priority in the prehospital group was to determine which prehospital interventions improve outcomes in critically ill patients. The competence of emergency care providers in performing common lifesaving skills was deemed the most important in clinical emergency care. Implementing and reviewing quality improvement systems scored the highest under general systems and safety management. Only 22 statements achieved consensus regarding study design. The National Department of Health was the preferred funding source, while private organisations and emergency care societies were identified as possible collaborative partners.Conclusion: This study provides expert consensus on priority research areas in emergency care in SA as a guide for emergency care providers to ensure evidence-based care that is relevant to the SA population

Resource tiered reviews – a provisional reporting checklist

AFJEM is committed to publishing review articles that will benefit acute care providers, independent of the resources available to them. As a result we have compiled a checklist aimed specifically at best evidence in the resource-restricted setting (Table 1). The aim is to guide authors in producing a report which is a combination between a clinical guideline and a systematic review. Best available evidence, using a transparent and systematic approach to find and evaluate relevant studies, is still key; but with additional focus on resource availability. In effect it will be more rigorous than a narrative review but less time-consuming than a systematic review or meta-analysis. In order to apply the content to different resource levels, authors are advised to start by describing the very best evidence available; then assume the resources for this level are not available and describe the next tier of evidence until all options are exhausted. For example, if we return to our patient with chest pain: the recommended treatment for a patient with STEMI is primary percutaneous coronary intervention; if this treatment is not available, then thrombolytics should be considered; if that is not available then antiplatelet therapy and anticoagulation should be used, and so on and so forth

A descriptive analysis of the effect of the national COVID-19 lockdown on the workload and case mix of patients presenting to a district-level emergency centre in Cape Town, South Africa

Background. The global COVID-19 pandemic caused many countries to institute nationwide lockdowns to limit the spread of the disease.Objectives. To describe the effect of the national COVID-19 lockdown in South Africa (SA) on the workload and case mix of patients presenting to a district-level emergency centre.Methods. The electronic patient tracking and registration database at Mitchells Plain Hospital, a district-level hospital in Cape Town, was retrospectively analysed. The 5-week lockdown period (27 March - 30 April 2020) was compared with a similar period immediately before the lockdown (21 February - 26 March). A comparison was also made with corresponding time periods during 2018 and 2019. Patient demographics, characteristics, diagnoses and disposition, as well as process times, were compared.Results. A total of 26 164 emergency centre visits were analysed (8 297 in 2020, 9 726 in 2019, 8 141 in 2018). There was a reduction of 15% in overall emergency centre visits from 2019 to 2020 (non-trauma 14%, trauma 20%). A 35% decrease was seen between the 2020 lockdown period and the 5-week period before lockdown (non-trauma 33%, trauma 43%), and the reduced number of visits stayed similar throughout the lockdown period. The median age increased by 5 years during the 2020 lockdown period, along with an 8% decrease in patients aged <12 years. High-acuity patients increased by 6% and the emergency centre mortality rate increased by 1%. All process times were shorter during the lockdown period (time to triage –24%, time to consultation –56%, time to disposition decision –29%, time in the emergency centre –20%).Conclusions. The SA national COVID-19 lockdown resulted in a substantial decrease in the number of patients presenting to the emergency centre. It is yet to be seen how quickly emergency centre volumes will recover as lockdown measures are eased

The epidemiology of operations performed by the National Sea Rescue Institute of South Africa over a 5-year period

Background: Injuries remain a major contributor of morbidity and mortality worldwide, with drowningaccounting for 7% of all injury-related deaths with rates of between 4 and 8 per 100,000. The Africanregion has death rates comparable to most low-income countries. Non-fatal drowning in Africa remainsunquantified but it is estimated to be ten times higher than the fatal drowning rate. Timely search andrescue, initial resuscitation and rapid transportation to definitive care play a crucial role in preventing injury-related morbidity and mortality. The National Sea Rescue Institute (NSRI) of South Africa is a non-profitorganisation responsible for ~97% of maritime search and rescue operations in South Africa (includinginland navigable waters). The aim of the study was to describe the epidemiology of operations performedby the NSRI of South Africa over a 5-year period.Materials and methods: The NSRI operational database was analysed from 1 January 2010 to 31 December2014. Summary statistics are presented.Results: The NSRI launched 3281 operations over the study period. Marked seasonal variation were noticeablewith peak periods in December and January, corresponding to the South African summer holidayseason. Water-based operations (67.6%) were the most frequent operation performed. The NSRI assisted3399 individuals of which 77% were male. The mean age of rescued persons was 42 years. Eight hundredand thirty-six (25%) individuals had non-fatal injuries or illnesses requiring medical assistance. Medicalemergencies (35%), traumatic injuries (32.8%), and non-fatal drownings (23%) were the most commontypes of injury and illness. The majority of the 184 (18%) deaths recorded were due to drowning (75%).Conclusions: Injury and illness, specifically drowning utilise a large proportion of search and rescue services.The results suggest further preventative measures and public health strategies be implemented tominimise traumatic and medical incident severity and subsequent casualties at sea

Watergerelateerde maatregelen melkveehouderij ter vermindering van de broeikasgasuitstoot op zand- en veengrond

In dit rapport zijn watergerelateerde maatregelen beschreven waarmee melkveehouders op veen en (droge) zandgrond een bijdrage kunnen leveren aan het reduceren van de emissie van niet-CO2-broeikasgassen. Dit in het kader van het meerjarige programma Reductieplan niet-CO2- Broeikasgassen (ROB, 1999-2010; programma van SenterNovem). De maatregelen zijn beschreven vanuit het praktijkperspectief van de WUR-praktijkcentra sector melkveehouderij Zegveld, Aver Heino en De Marke

Indicator voor stikstofmineralisatie op gescheurd grasland = Indicator of nitrogen mineralisation on broken meadowland

This report addresses the results of an experiment with field trials with potatoes and silage maize onsandy soil in 2006 in order to obtain a suitable indicator for predicting N-mineralisation after ploughing the grassland. This study is part of a larger project with more field trials and a laboratory experiment. Ploughed grassland on the locations selected provided much nitrogen, due to which it was not possible to infer an indicator from the crop response for adjusting nitrogen recommendation. N-total seems to be the most promising parameter in predicting nitrogen mineralisatio

Water kent geen grenzen : samen werken aan agrarisch waterbeheer

Waterbeheer door boeren, waarbij het nog de vraag is of grootschalige toepassing op boerenbedrijven mogelijk is. Voorbeelden zijn het project Functionele Agrobiodiversiteit (FAB) Hoeksche Waard (p. 9) en demonstratieprojecten bij individuele boeren, zoals het agrarische informatiebedrijf Helder Water (pag 8.) en het project Boeren met water (p. 9). Stuwbeheer, waterzuivering en rietteelt zijn andere voorbeelden van waterbeheer door boere