175 research outputs found

    Variables required for the audit of quality completion of patient report forms by EMS : a scoping review

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    This review aimed to compile a list of essential variables from the patient assessment, care provided out-of-hospital and the patient handover over process that should be recorded on a Patient Report Form (PRF). A scoping review was conducted to identify articles concerning the recording of medical information on the PRF in the prehospital environment. Methods: A three-step search strategy was used to systemically search published literature. A Boolean method using synonymous phrases related to patient handover variables required for PRF competition was developed based on an initial online search of key phrases. Using the Boolean phrase, a scoping review (guided by a protocol developed a priori) was conducted. The search was conducted using PubMed, CINAHL, Summon and Scopus. A PCC framework was used to guide the inclusion criteria of identified articles. Results: The database search yielded 2461 results. Duplicates (n = 736), articles published prior to the year 2000 n = 260), and non-English results (n = 30) were removed. The remaining 1435 articles underwent title and abstract screening to determine the relevance to the study topic. This resulted in articles apparently relevant to the study (n = 47) and these underwent full-text review. Following full-text review 25 articles were included in the study. Patient related information and variables detailing the condition of the patient, including, patient demographics, vital signs, patient assessment and treatment initiated and the manner in which this information is transferred during the patient handover are factors that are important during patient hand over. Conclusion: The information on the PRF prevents potential loss of critical patient information and details of the patient’s condition and treatment from the prehospital field. The development of an appropriate checklist to quality assure PRF’s by ensuring that all vital information is captured on the PRF is proposed

    A trauma system for KwaZulu-Natal : local development for local need.

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    Ph. D. University of KwaZulu-Natal, Durban 2013.Introduction: The need for Trauma Care in South Africa is without question one of the four major health issues facing the country and indeed the African continent today. First-world developed systems focus on the care of trauma from prevention to rehabilitation, yet in Africa the issue of access to even resuscitation is often the challenge faced by communities in poverty. The philosophical concepts which underpin the main thrust of the thesis are summarised as the introductory chapter. “The 11 P’s of an Afrocentric trauma system for South Africa” and “Guideline for the assessment of trauma centres for South Africa” were the result of this literature review. “Trauma care in South Africa: From humble beginnings to an afrocentric outreach” examines the history of trauma care in South Africa and the current desire to be relevant to the greater African Continent, highlighting the realities of practicing trauma care in this country. Local development is essential with regionally specific injury profiles, especially in a country like South Africa with very high trauma rates when compared to the rest of the world. Aim: This PhD submission aims to review the practical problems and the ethical issues facing trauma in South Africa. This submission examines the current burden of disease of live-injured patients entering the existing informal system in KwaZulu-Natal, both at a prehospital and in-hospital level of care. This submission also examines the current facilities and transfer processes within the government hospital sector, including specifically the utilization of the Level 1 Trauma Centre at Albert Luthuli Central Hospital. The submission aims to provide a solid provincial dataset on which to design a proposal for a practical system of trauma care across the province, and that may be potentially exportable to the rest of the country, and to Africa. Methods: This PhD proposal provides the evidence for the achievement of the stated aims through the submission of linked papers published in peer-reviewed medical journals relevant to the field of study covering an overview of the literature, examination of the ethical challenges in trauma facing South Africa, and the need for trauma systems. The current prehospital and hospital disease burden is examined and facility structure and staff skill-sets reviewed. A review of utilisation of and need for a major trauma centre is undertaken. Finally the thesis proposes an appropriate regionalised trauma system, emphasising the need for more such facilities across the province. The methods were described in the approved protocol and these are presented in the overview chapters. Results: The three papers that form the thrust of the scientific contribution of this work were all published in July 2013 in World Journal of Surgery and are as follows: 1. The Prehospital Burden of Disease due to Trauma in KwaZulu-Natal: The Need for Afrocentric Trauma Systems. 2. An Assessment of the Hospital Disease Burden and the Facilities for the In-hospital Care of Trauma in KwaZulu-Natal,South Africa. 3. Utilisation of a Level 1 Trauma Centre in KwaZulu-Natal: Appropriateness of Referral Determines Trauma Patient Access All three studies received BREC approval (BE011/010). The essential methodology, findings and conclusions derived from these three papers are outlined here: Paper 1: Methods: Using a convenience data set all Emergency Medical Service (EMS) call data for the months of March and September 2010 were reviewed for the three main EMS providers in KZN. Data were extrapolated to annual data and placed in the context of population, ambulance service, and facility. The data were then mapped for area distribution and prehospital workload relative to the entire province. Questionnaire-based assessments of knowledge and deficiencies of the current system were completed by senior officers of the provincial system as part of the analysis of the current system. Results: The total annual call burden for trauma ranges between 94,840 and 101,420, or around 11.6 trauma calls per thousand of the population per year. Almost 70 % of calls were either for interpersonal intentional violence or vehicular collisions. Only 0.25 % of calls involved aeromedical resources. Some 80 % of patients were considered to be moderately to seriously injured, yet only 41 % of the patients were transported to a suitable level of care immediately, with many going to inappropriate lower level care facilities. Many rural calls are not attended within the time norms accepted nationally. Deficiencies noted by the questionnaire survey are the general lack of a bypass mechanism and the feeling among staff that most EMS bases do not have a bypass option or feel part of a system of care, despite large numbers of staff having been recently trained in triage and Conclusions: The prehospital trauma burden in KZN is significant and consumes vital resources and gridlocks facilities. A prehospital trauma system that is financially sustainable and meets the needs of the trauma burden is proposed to enable Afrocentric emergency care planning for low and middle income regions. Paper 2: Methods: Hospital administrators in KZN were requested to submit trauma caseloads for the months of March and September 2010. Caseloads were reviewed to determine the trauma load for the province per category using two extrapolation methods to determine the predicted range of annual incidence of trauma, intentional versus non-intentional trauma ratios and population-related incidence of trauma. The results were GIS mapped to demonstrate variations across districts. Hospital data were obtained from assessments of structure, process, and personnel undertaken prior to a major sporting event. These were compared to the ideal facilities required for accreditation of trauma care facilities of the Trauma Society of South Africa and other established documents. Results: Data were obtained from 36 of the 47 public hospitals in KZN that manage acute emergency cases. The predicted annual trauma incidence in KZN ranges from 124,000 to 125,000, or 12.9 per 1,000 population. This would imply a national public hospital trauma load on the order of at least 750,000 cases per year. Most hospitals are required to treat trauma; however, within KZN many hospitals do not have adequate personnel, medical equipment, or structural integrity to be formally accredited as trauma care facilities in terms of existing criteria. Conclusions: There is a significant trauma load that consumes vital emergency center resources. Most hospitals will need extensive upgrading to provide appropriate care for trauma. An inclusive trauma system needs to be formalized and funded, especially in light of the planned National Health Insurance for South Africa. Paper 3: Methods: An audit was performed of the referral proformas used in the unit to record admission decisions and of the computerised trauma database. The audit examined referral source (scene vs. interhospital), regional distribution, and final decision regarding admission of the injured patients. The study was approved by the UKZN Ethics Committee (BE207/09 and 011/010). Results: Of the 1,212 external consults, 540 were accepted for admission while the rest were not accepted for various reasons. These included 206 cases where no bed was available, 233 did not meet admission criteria (minor injury or futile situation), and 115 were for subspecialty management of a single-system injury. Finally, 115 were initially refused pending stabilisation for transfer at a regional facility. Twenty-six percent of the cases were referrals from the scene, with an acceptance rate of 96 %. Most patients (59 %) were from the local eThekwini region. Conclusion: Major multiorgan system trauma remains a significant public health burden in KwaZulu-Natal. A Level 1 Trauma Service is used appropriately in most circumstances. However, the additional need for more hospital facilities that provide such services across the whole province to enable effective geographical coverage for those trauma patients requiring such specialised trauma care is essential. After evaluation of the submitted papers a summative chapter is provided as to how they provide a framework to design a Trauma System relevant to KZN, South Africa and potentially Africa. Overall Conclusions: In the developed world trauma systems have been shown to substantially reduce mortality and morbidity after major and moderate trauma. Few such systems and centres of excellence exist within the developing world scenario. The solutions offered by such systems may not be entirely relevant to the African scenario. A trauma system relevant to KwaZulu-Natal, South Africa and the African continent is essential to reduce the huge mortality burden in low to middle income regions, where trauma is a major source of reduced life-years. The results of the studies presented here are valuable in providing insight to the needs and potential solutions to the challenges faced in our environment. A plea is therefore made for pilot implementation at provincial level. This will involve further research into the feasibility of introduction and how such an introduction could be audited and refined for broader adoption in South Africa and the African continent

    Complications of tube thoracostomy for chest trauma

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    Objective. To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings. Methods. Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department’s records and monthly statistics. Results. A total of 3 989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8%) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92%) of these had been referred with an ICD in situ. An overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity). Conclusion. Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion

    An analysis of patients transported by a private helicopter emergency medical service in South Africa

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    Background. A helicopter emergency medical service (HEMS) is a specialist flying emergency service where on-board medical personnel have both the knowledge and equipment to perform complicated medical procedures. The paucity of literature describing the types of patients flown by HEMS in South Africa (SA) and their clinical outcome poses a challenge for current aeromedical services, as there is no baseline information on which to base flight criteria, staffing and policy documents. This has the potential to hamper the advancement of HEMS in SA.Objectives. To undertake a descriptive analysis of patients flown by the Netcare 911 HEMS over a 12-month period in Gauteng and KwaZulu-Natal (KZN) provinces, SA, and to assess patient outcomes. The clinical demographics of patients transported by the HEMS were analysed, time frames from dispatch of the helicopter to delivery of the patient to the receiving hospital determined, and patient outcomes at 24 hours and 72 hours analysed.Methods. The study utilised a retrospective quantitative, descriptive design to analyse patients transported by a private HEMS in SA. All complete records of patients transported by the Netcare 911 HEMS between 1 January and 31 December 2011 were included.Results. The final study population comprised 537 cases, as 10 cases had to be excluded owing to incomplete documentation. Of the 537 cases, 82 (15.3%) were managed by the KZN HEMS and 455 (84.7%) by the Gauteng HEMS. Adult males were the patients most commonly flown in both Gauteng and KZN (350/455 patients (76.9%) in Gauteng and 48/82 (58.5%) in KZN were males, and 364/455 patients (80.0%) in Gauteng and 73/82 (89.0%) in KZN were adults). Motor vehicle collisions were the most common incidents necessitating transport by HEMS in both operations (n=193, 35.9%). At the 24-hour follow-up, 339 patients (63.1%) were alive and stable, and at the 72-hour follow-up, 404 (75.3%) were alive and stable.Conclusion. The study findings provided valuable information that may have an impact on the current staffing and authorisation criteria of SA HEMS operations

    Radio constraints on dark matter annihilation in Canes Venatici I with LOFAR

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    This article has been accepted for publication in Monthly Notices of the Royal Astronomical Society ©: 2020 The Author(s). Published by Oxford University Press on behalf of the Royal Astronomical Society. All rights reserved.Dwarf galaxies are dark matter-dominated and therefore promising targets for the search for weakly interacting massive particles (WIMPs), which are well-known candidates for dark matter. Annihilation of WIMPs produce ultra-relativistic cosmic-ray electrons and positrons that emit synchrotron radiation in the presence of magnetic fields. For typical magnetic field strengths (few Ό\mu G) and O\mathcal O(GeV-TeV) WIMP masses (and thus typical electron energies of the same order) this emission peaks at hundreds of MHz. Here, we use the non-detection of 150-MHz radio continuum emission from the dwarf spheroidal galaxy `Canes Venatici I' with the LOw-Frequency ARray (LOFAR) to derive constraints on the annihilation cross section of WIMPs into primary electron-positron and other fundamental particle-antiparticle pairs. In this first-of-its-kind LOFAR study, we obtain new constraints on annihilating WIMP dark matter (DM). Using conservative estimates for the magnetic field strengths and diffusion coefficients, we obtain limits that are comparable with those by the Fermi Large Area Telescope (Fermi-LAT) using gamma-ray observations. Assuming s-wave annihilation and WIMPs making up 100% of the DM density, our limits exclude several thermal WIMP realisations in the [2,20][2,20]-GeV mass range. A more ambitious multi-wavelength and multi-target LOFAR study could improve these limits by a few orders of magnitude.Peer reviewe

    Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence

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    BACKGROUND:Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. METHODS: The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n = 5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR) < 0.5-were collated into the algorithm. RESULTS: The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. CONCLUSION: An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population

    Filaments in the southern giant lobe of Centaurus A : Constraints on nature and origin from modelling and GMRT observations

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    Date of acceptance: 22/05/2014We present results from imaging of the radio filaments in the southern giant lobe of CentaurusA using data from Giant Metrewave Radio Telescope observations at 325 and 235 MHz, and outcomes from filament modelling. The observations reveal a rich filamentary structure, largely matching the morphology at 1.4 GHz. We find no clear connection of the filaments to the jet. We seek to constrain the nature and origin of the vertex and vortex filaments associated with the lobe and their role in high-energy particle acceleration. We deduce that these filaments are at most mildly overpressuredwith respect to the global lobe plasma showing no evidence of largescale efficient Fermi I-type particle acceleration, and persist for ~2-3 Myr. We demonstrate that the dwarf galaxy KK 196 (AM 1318-444) cannot account for the features, and that surface plasma instabilities, the internal sausage mode and radiative instabilities are highly unlikely. An internal tearing instability and the kink mode are allowed within the observational and growth time constraints and could develop in parallel on different physical scales. We interpret the origin of the vertex and vortex filaments in terms of weak shocks from transonic magnetohydrodynamical turbulence or from a moderately recent jet activity of the parent AGN, or an interplay of both.Peer reviewe

    An analysis of exercise science and exercise physiology work-integrated learning supervision in Australia

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    Currently, 33 Universities in Australia offer exercise science (ES) and/or exercise physiology (EP) programs linked to Exercise and Sports Science Australia (ESSA). Within these programs, work-integrated learning (WIL) is a mandated component for all enrolled students. Paramount to successful delivery of WIL is adequate, competent practicum supervision. This, in turn, is essential to evidence-based practice training and development of work-ready ES and EP students. However, while these industry professionals are key leaders in WIL, there is significant variability in supervisory practice, including experience, training and approach to supervision. This research aims to identify characteristics and demographic profile of supervisors in this setting, as well as capture their experience and perceived needs to better support ES and EP students on WIL placement. It builds on previous research, a report published by researchers from four Australian Universities on the state of EP placement supervision across Australia (Sealey et al., 2013). While this research provided a valuable starting point from which to develop evidence-based support, the industry has since changed and grown exponentially. For example, 4,481 students in 2018 alone commencing an ES, EP or combined degree, making collection of such data imperative to forecast industry ability to provide sufficient WIL and areas for expansion. Additionally, earlier studies did not include ES-related WIL, which is a prerequisite and provides foundation clinical WIL for those students progressing to EP. Survey data collected captured both quantitative and qualitative information to gain a broader perspective of the supervision landscape. This information will provide crucial base-line data of the current WIL environment across Australia and enable the development and delivery of targeted support and training for supervisors, and ultimately the students placed under their leadership
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