Johannesburg Hospital Research Articles

Awareness of genetic counseling services among allied healthcare professionals in South Africa.

Genetic counseling has been shown to increase patient empowerment leading to positive outcomes. However, in the Johannesburg state healthcare system, the genetic counseling service is underutilized. Individuals with genetic disorders present with a variety of symptoms and are frequently referred to allied healthcare professionals for management; therefore, these professionals are in a unique position to identify appropriate patients and refer them for genetic counseling. This study aimed to determine whether allied health professionals, including physiotherapists, occupational therapists, and speech and language therapists, were aware of genetic counseling services in Johannesburg, South Africa, and whether they had previously referred patients to these services. The study also aimed to identify barriers and facilitators to referral. An adapted paper-copy questionnaire was administered to allied health professionals working at one of three state hospitals in Johannesburg. A total of 57 participants were included in this study. Results indicated that 29/57 (50.9%) of allied health professionals knew that genetic counseling services were available but only 15/29 (51.7%) of those who knew of the service had referred patients to these services in the last year. Barriers to referral included misconceptions about the role of genetic counselors, insufficient knowledge of which patients would benefit from genetic counseling, and being unable to obtain appropriate information from the Genetics Clinic for patient referral. However, allied health professionals recognized the benefit of genetic counseling and 53/57 (93%) wanted to increase their genetics knowledge. Therefore, genetics education of allied health professionals, and improved information regarding the referral procedure for genetic counseling, may improve the number of patients referred.

Treatment outcomes among patients admitted to hospital with antiretroviral and/or antituberculosis drug-induced liver injury.

South Africa (SA) has among the highest rates of HIV and tuberculosis (TB) in the world. Antituberculosis and antiretroviral treatment (ART) can cause drug-induced liver injury (DILI), consequences of which are disease relapse, treatment failure and drug resistance. To: (i) determine the demographics of patients with DILI and the proportion of patients on antituberculosis drugs v. antiretroviral therapy or both; (ii) determine the median time to DILI after starting medication, and patterns of clinical presentation; (iii)determine the numbers of patients successfully re-challenged to initial therapy as inpatients; and (iv) determine the in-hospital mortality rate and predictors of all-cause mortality. This was a retrospective record review of adult patients with DILI admitted to a tertiary hospital in Johannesburg, SA, between October 2015 and February 2017. Data on drug history, biochemical investigations and relevant imaging were collected. The total sample was 129 records: 79 (61.2%) were males, 46 (35.7%) had TB DILI, 29 (22.5%) had ART DILI, and 54 (41.9%) had mixed TB/ART DILI. Only 7.4% (2/27) of those with ART DILI and 30.6% (11/36) with TB DILI were re-challenged to their original regimen by discharge. Patients were followed from admission until the earlier of death (10 with TB DILI, 2 with ART DILI and 9 with mixed DILI) or discharge (after a median (interquartile range) of 14.0 (9 - 23) days). In adjusted analysis, severe DILI at admission predicted all-cause mortality (adjusted hazard ratio 8.58; 95% confidence interval 1.13 - 65.4). This study is one of only a few analyses of hospitalised patients with DILI in SA. Among those with severe DILI, outcomes are poor, the majority cannot tolerate standard regimens, and mortality is high.

Neonatal surgical outcomes: a prospective observational study at a Tertiary Academic Hospital in Johannesburg, South Africa.

The neonatal period is the most vulnerable period for a child. There is a paucity of data on the burden of neonatal surgical disease in our setting. The aim of this study was to describe the frequency with which index neonatal surgical conditions are seen within our setting and to document the 30-day outcome of these patients. This was a single-centre prospective observational study in which all neonates with paediatric surgical pathology referred to the paediatric surgical unit with a corrected gestational age of 28days were included. Necrotising enterocolitis was the most frequent reason for referral to the paediatric surgical unit (n = 68, 34.34%). Gastroschisis was the most frequent congenital anomaly referred (n = 20, 10.10%). The overall morbidity was 57.58%. Surgical complications contributed to 18.51% of morbidities. The development of gram negative nosocomial sepsis was the most frequent cause of morbidity (n = 98, 50.78%). Mortality at 30days was 21.74% (n = 40). Sepsis contributed to mortality in 35 patients (87.5%), 16 of which had gram negative sepsis. Gram-negative sepsis was a major contributing factor in the development of morbidity and mortality in our cohort. Prevention and improvement in infection control are imperative if we are to improve outcomes in our surgical neonates.

Stress ulcer prophylaxis use in critical care units at public hospitals in Johannesburg, South Africa.

Background Stress ulcer prophylaxis (SUP) is part of the management of critically ill patients in intensive care units (ICUs). However, inappropriate use of these drugs has important clinical implications such as ventilator-associated pneumonia and Clostridium difficile-associated gastrointestinal tract infections. The overuse of proton pump inhibitors (PPIs) as SUP is a rapidly growing problem globally. Objectives To describe the use of SUP in three selected ICUs in Johannesburg, South Africa (SA). Methods A retrospective, descriptive, contextual study design was used. Data were collected from ICU records of adult patients admitted into these units during the study period (1 August 2013 - 31 October 2013). Results A total of 174 patients were included in the study. Of these, 156 were on SUP and only 38.5% (n=60/156) were appropriately treated with SUP according to the American Society of Health-System Pharmacists guidelines. There was an inappropriate use of SUP in over 50% of those who were treated. The most frequently prescribed SUP was histamine-2 receptor antagonist (H2RA) (51.3%; n=80/156), followed by PPIs (30.8%; n=48/156), sucralfate (17.3%; n=27/156), and a combination of PPI and H2RA (0.6%; n=1/156). Conclusion The study demonstrated overuse of SUP. The most commonly used drug for SUP was H2RA and not PPIs. This study demonstrates that the problem of SUP overuse internationally also exists locally. The development of local guidelines may help to improve the practice of SUP in SA. Contributions of the study This study showed overuse of SUP and should encourage doctors to critically evaluate why they prescribe SUP and whether it is really indicated. This should help in the adoption of practices towards appropriate use of SUP.

Out of the Loop: The Value of a Preoperative Loopogram for Colostomy Reversal in Trauma.

Stoma is occasionally fashioned during trauma surgery. A loopogram is routinely conducted in the surgical planning for stoma reversal. This is associated with medical and cost implications. A study was undertaken to evaluate the influence of loopograms on the management of trauma patients at a Johannesburg hospital. A retrospective analysis of records in the stoma database (January 2013 to December 2018) was conducted. The patient demographics, method of injury, stoma-type, loopogram findings and post-operative courses were analysed. 112 records were obtained. 9 (8%) patients were excluded for pending investigations or surgery. 13 (11.6%) patients were excluded for incomplete data. The remaining 90 (80.3%) patients, with a mean age of 32.9 had non-contributory loopograms and underwent a reversal procedure. 43 (47.8%) had a loop colostomy while 47 (52.2%) had undergone a Hartmann's procedure. Mechanism of injury was stab wounds (81.4%L; 61.7%H); gunshot wounds (13.9%L; 29.7%H) and blunt trauma (L5% and 9%H). The post-operative complication rate was 30% for the loop group (2.3% ≥ Clavien-Dindo 3) and 25.5% for the Hartmann's group (4% ≥ Clavien-Dindo 3). The average timing to reversal was 38weeks (range 12-60) in the Hartmann's group and 22weeks (range 12-32) the loop colostomy group. Significant findings are infrequent on loopogram for trauma patients. When these findings are detected, the effect on management is questionable. They are not without complications and have cost and time implications. Loopograms are helpful in selective cases rather than as a routine investigation, particularly in resource-limited settings.

Outcomes of newborn hearing screening at an academic secondary level hospital in Johannesburg, South Africa.

BackgroundThe Health Professions Council of South Africa (HPCSA) issued early hearing detection and intervention guidelines, which has universal newborn hearing screening (UNHS) as one of the important goals. Despite established evidence of the importance of UNHS globally, there has been no mandated formalised and standardised implementation as yet in South Africa.ObjectivesThe aim of this study was to describe the outcomes of newborn hearing screening (NHS) in an academic secondary level hospital in Johannesburg, South Africa.MethodsThis was a prospective non-experimental feasibility study over a 3-month period, involving conducting hearing screening of 121 neonates. Audiologists conducted a risk factor assessment, otoscopic examinations and distortion product otoacoustic emissions (DPOAEs) screening on each neonate, with follow-up appointments for re-screening and diagnostic audiological assessments for all neonates with refer findings. Data were analysed using STATA intercooled version 11©, through both descriptive and inferential statistics (Fisher’s exact test), with significance established where p-values less than 0.05 were considered statistically significant.ResultsOf the 121 neonates screened, the majority (75%) were screened in the first 24 h of life. A high refer rate (47%) of the total sample was found on DPOAE screening. No maternal or neonatal risk factors were found to be significantly associated with refer findings.ConclusionFindings contribute towards the existing evidence base that raises implications for successful implementation of NHS programmes in public healthcare in South Africa. Screening protocols need to consider the timing of screening, the measures and procedures adopted in the screening protocols, as well as the follow-up strategies.

Knowledge, attitudes and practices of hospital-based staff regarding physical activity at a private hospital in Johannesburg.

BackgroundPhysical activity has been established as an important component to incorporate into a healthy lifestyle. Hospital-based staff are also threatened by the risks of sedentary lifestyles, despite their association with a healthcare environment. The aim of this study was to determine the knowledge, attitudes and practices of private hospital-based staff regarding physical activity in Johannesburg.MethodsA cross-sectional study was conducted. Data were collected using a self-administered questionnaire. Data were analysed with a combination of descriptive and inferential statistics. A p-value less than 0.05 was deemed statistically significant.ResultsA total number of 217 participants responded to the questionnaire. The majority of participants (n = 179; 82.49%) displayed excellent knowledge of physical activity, had a good attitude towards physical activity (n = 157; 72.35%) and displayed satisfactory practices (n = 137; 63.13%). Participants with the highest level of education had better mean knowledge, attitude and practice scores as opposed to those with lower levels of education. There was a statistically significant difference amongst staff categories in terms of knowledge (p = 0.004) and practice scores (p = 0.031). In addition, there was a statistically significant difference amongst different levels of education in terms of knowledge (p = 0.000), attitude (p = 0.02) and practice scores (p = 0.004).ConclusionStaff members who participated in the study displayed only satisfactory physical activity practices. The hospital’s employee wellness programme should establish appropriate strategies to improve staff practices of physical activity in order to promote health.

Perioperative outcomes of coronary artery bypass graft surgery in Johannesburg, South Africa

BackgroundThe perioperative complications in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery have been reported predominantly from developed countries, with a paucity of data from sub-Saharan Africa. We aim to report on the clinical characteristics and perioperative complications in patients with obstructive coronary artery disease, managed with CABG surgery at a tertiary academic hospital in Johannesburg, South Africa.MethodsWe retrospectively reviewed data from adult patients who underwent CABG surgery during a 17-year period (January 2000 – December 2017). Data was collected from the cardiothoracic surgery department’s pre- and postoperative reports, the cardiology department’s medical records, and anaesthesiology’s intra-operative reports. We collected demographic, biochemical, clinical, surgical, echocardiographic, and angiographic data. Outcomes data collected included perioperative complications and mortality.ResultsWe analysed 1218 consecutive patient records. The study cohort consisted of 951 (78.1%) males, and the mean age was 60.1 ± 10.1 years. During the study period, 137 (11.2%) patients demised with cardiac and sepsis-related causes of death accounting for 49.6 and 37.2%, respectively. Other perioperative complications included excessive bleeding in 222 (18.2%), prolonged ventilation (exceeding 48 h) in 139 (11.4%), and sternal sepsis in 125 (10.3%). On univariate logistic regression analysis, advanced age, a lower left ventricular ejection fraction, smoking, increased cardiopulmonary bypass (CPB) time, and a higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II were all significantly associated with mortality. The EuroSCORE II [OR: 0.15 95%CI: 0.09–0.22; p = 0.000], and prolonged CPB time [OR: 0.01 CI: 0.00–0.02; p = 0.000] were independent predictors of in-hospital all-cause mortality.ConclusionsIn our study, the crude perioperative mortality rate was 11.2%. Our mortality rate was significantly higher than the mortality rates reported in other developed and developing countries. To better understand the factors driving this high mortality rate, a prospective outcomes registry has been initiated, and this promises to inform on our contemporary mortality and morbidity outcomes.

An audit of HIV-infected Patients Admitted to Helen Joseph Hospital in Johannesburg, South Africa

ABSTRACT Background: South Africa has the largest HIV-infected population and treatment programme in the world. ART access has increased since 2004 with the current policy of universal test and treat (UTT). South Africa has had some success toward the UNAIDS 90-90-90 targets but high numbers of HIV related complications and treatment failure persist despite universal access to ART. The aim of this study was to assess the proportion of patients admitted to a general medical ward with HIV infection and to calculate the median CD4 count of these patients. Methods: A clinical audit in which baseline data was collected from all patients admitted to a single medical unit at Helen Joseph Hospital in Johannesburg from September 2018 to January 2019. The number of admissions of people living with HIV (PLWH) was assessed and median CD4 count and viral loads were calculated. The indications for admission of PLWH and HIV-negative patients were also compared. Results: The median CD4 cell count of PLWH was 67 cells/µl (IQR 23-259.5). Of the 794 medical admissions 42.4% were HIV-infected. Of the cohort of HIV-infected patients, over a quarter were newly diagnosed on admission. Furthermore, 46.1% of patients on treatment were failing ART. More than 10% of HIV-infected patients had interrupted treatment and 10.5% of patients previously known to be HIV-infected had not yet initiated treatment. AIDS-defining conditions accounted for 40.1% of the admissions. Conclusion: Despite a policy of UTT, a high proportion of medical admissions to a public hospital in South Africa are in PLWH. Median CD4 counts remain low in hospitalised HIV positive patients despite universal access to ART. Large numbers of PLWH are not accessing or are disengaging from HIV care.

Prevalence and factors associated with fear of hypoglycaemia among adults with Type 1 diabetes mellitus at an academic hospital in South Africa

Hypoglycaemia is one of the most common and acute complications in the management of diabetic patients. The study conducted at an academic hospital in Johannesburg, Gauteng province, South Africa, purposed to determine the prevalence and risk factors for fear of hypoglycaemia in Type 1 Diabetes Mellitus patients.This cross-sectional study used the 15-item Fear of Hypoglycaemia (FH) scale to collect data from patients diagnosed with Type 1 Diabetes Mellitus and on insulin therapy at an academic hospital in Johannesburg. Patients with a score of 22 or more were classified as suffering from fear of hypoglycaemia.The prevalence of FH was 64.4%. Participants with FH were significantly younger by 10 years – than those with no FH (p = 0.012). There was no significant association between certain socio-demographic variables and FH, or between the monitoring of blood glucose levels and FH (p = 0.448). However, there was a significant association between the monitoring of blood glucose levels and worrying about hypoglycaemia (p = 0.021).This study reported high levels of fear of hypoglycaemia and an association between the monitoring of blood glucose levels and anxiety about hypoglycaemia. The diabetic condition of most of the participants was found to be is well controlled.

Influence of COVID-19 Pandemic on Health-care Workers’ Hand Hygiene Practice at a Private Academic Hospital in Johannesburg, South Africa: A Quantitative and Qualitative Longitudinal Study

ABSTRACT Background: Hand hygiene (HH) is a cornerstone infection prevention measure and is crucial in the fight against the COVID-19 pandemic. Improving and monitoring of HH compliance in a hospital setting is a complex challenge given the behavioural component associated with it. We aimed to assess the impact of the COVID-19 pandemic on HH compliance using both quantifiable hand product usage and observational data. Methods: Using the hospital's HH usage monitoring system, the quantity of different HH products per nursing unit, expressed as millilitres (mL) per patient bed day (PBD), was analysed longitudinally during the course of the pandemic. Observational HH compliance data was drawn from the hospital audit system for comparison. Results: Across all units, there was a significant increase in HH product usage coinciding with the onset of the pandemic (53 mL/PBD to 111 mL/PBD, in non-critical care units (non-CCU's); 127 mL/PBD to 217 mL/PBD, in CCU's). This increase was largely attributable to an increase in alcohol-based hand rub usage. Discordance with observed compliance rates was noted. Conclusion: An unprecedented increase in HH product usage in a hospital setting was seen to coincide with the onset of the COVID-19 pandemic. No specific HH campaign was introduced, and the improved usage compliance appears to be driven primarily by health-care workers’ own behavioural change.

An observational study of acute kidney injury in critically ill neonates at Chris Hani Baragwanath Academic Hospital, South Africa

Background: Acute kidney injury (AKI) is common in critically ill, hospitalised neonates. Epidemiological data on AKI in children are scarce in South Africa. This study aimed to determine the incidence and outcomes of AKI in critically ill neonates. Methods: This single-centre, prospective, observational study was conducted in the neonatal unit of the Chris Hani Baragwanath Academic Hospital, a tertiary-level hospital in Johannesburg, South Africa. Neonates with AKI, defined using the AKI Network criteria, were recruited over a three-month period in 2019. Risk factors and demographic data were collected for all study participants, who were followed up over the period to observe an outcome of either recovery or death. Results: Fifty-one cases of AKI were identified, representing 7.8% of all admissions (95% CI 5.9–10.2%). The overall mortality of enrolled patients was 29.4% (95% CI 26.3–56.1%). Mortality was significantly associated with extremely low birth weight (OR 11.4, p < 0.01), umbilical catheterisation (OR 6.3, p = 0.01), sepsis (OR 5.4, p = 0.01), phototherapy (OR 4.4, p = 0.03) and prematurity (p = 0.04). The most frequent risk factor associated with AKI was intravenous nephrotoxic medication. Conclusion: The incidence of AKI in our study was higher than expected. Further epidemiological and interventional studies are warranted to identify and improve the long-term outcome of AKI in the newborn in our setting.

Impact of a Bisphosphonate Drug Holiday on the Bone Mineral Density in Patients with Osteoporosis

ABSTRACT Background: Bisphosphonate therapy has proven efficacy in the management of osteoporosis. Unlike other therapies, bisphosphonates are unique in that they continue inhibiting bone resorption after a discontinuation of therapy. Rare adverse effects related to its prolonged use, specifically osteonecrosis of the jaw and atypical femur fractures, resulted in the concept of a “drug holiday” (DH). Objective: To evaluate the effect of a bisphosphonate DH on bone mineral density (BMD) in the treatment of osteoporosis with zoledronic acid and/or alendronate. Methods: A single-centre retrospective cohort study of 97 patients with osteoporosis who had received bisphosphonate therapy and undertaken a DH between 2000 and 2016 was conducted at a large public academic hospital in Johannesburg, South Africa. Results: A total of 97 patients were included in the study. The median age at the initiation of bisphosphonate therapy was 63 years. The median duration of treatment before the DH was 5 years with the median duration of the DH being 2 years. The overall effect of the DH on BMD assessed as the percentage change from the beginning to the end of the DH showed a decrease in BMD lumbar spine [−3.3%, P = 0.398], radius and ulnar [−16.7%, P = 0.03] and total hip [−8.9%, P = 0.001]. Four patients (4.1%) sustained fractures during the DH. Conclusion: A DH should be cautiously considered with the long-term use of bisphosphonates. An individualised approach based on risk factor assessment, fracture risk, and BMD is key in assessing the duration of the DH, and only low-risk patients should be considered.

Clinical Characteristics, Maternal and Neonatal Outcomes of COVID-19 Positive Pregnant Mothers at a Tertiary Hospital in Johannesburg, South Africa

Background: The global spread of the novel coronavirus 2019 (COVID-19) has been sudden shock to the world and resulted in many questions that remain unanswered. Limited data has been published in low-middle-income country settings (LMICS).

Clinical Characteristics and Complications in Patients Undergoing Permanent Pacemaker Implantation

Abstract Background: Pacemakers are electronic impulse generators that are implanted to restore a regular heart rhythm in patients with symptomatic bradycardia. A large body of epidemiological data on permanent pacemaker implantation (PPI) originates from developed countries with minimal data from developing regions, especially sub-Saharan Africa. This study aims to describe patient demographics, clinical indications, short-term and long-term complications in patients undergoing PPI at the Charlotte Maxeke Johannesburg Academic Hospital, which is a large urban public teaching hospital in Johannesburg, South Africa. Methods: We retrospectively reviewed in-patient and out-patient medical records of consecutive patients who underwent index PPI over ten years (January 2009 to November 2018). Results: The study cohort comprised of 565 patients, of which 325 (57.52%) were female. The median age at first PPI was 71.8 [interquartile range: 61.7–78.8] years. The indications for pacemaker implantation were atrioventricular (AV) block in 417 (73.81%) and sinus node dysfunction in 114 (20.18%). A total of 40 (7.08%) patients experienced PPI-related complications. Lead dislodgement was the most common complication occurring in 16 (3.05%) patients. Females were 3.8 times more likely to experience a complication [odds ratio (OR): 3.80; 95% CI: 1.40–10.32, P = 0.009]. Conclusion: In this study, AV block was the most common indication for PPI, and the complication rate was found to be 7.08%. Furthermore, the risk of developing a complication was significantly higher in females.

Proteogenomic analysis demonstrates novel potential targets of pancreatic ductal adenocarcinoma in African patients

Pancreatic ductal adenocarcinoma (PDAC) accounts for 2.8% of new cancer cases worldwide and is projected to become the 2nd leading cause of cancer-related deaths by 2030. Patients of African ancestry appear to be at increased risk for PDAC with the worst severity and outcome.This proposed study sought to determine and integrate proteomic and genomic profiles of PDAC patients of African ancestry to identify potential markers and better understand molecular mechanisms of the disease, especially in our population cohort. Thirty tissues (15 tumours and 15 corresponding normal tissues) were obtained from consenting South African PDAC patients undergoing Whipple procedure at Chris Hani Baragwanath Hospital in Johannesburg, South Africa (HREC-M150778). Protein and DNA were extracted from tissue samples and SWATH Mass Spectrometry and OncoArray anlaysis performed. Network and functional analysis were conducted using STRINGv11.0 and REACTOMEv70. We also used the Variant effect predictor (VEPv98) tool to predict consequences of the SNPs observed. We found 55 upregulated and 36 downregulated proteins in tumour samples which were mostly involved in key biological processes, including haemostasis, signal transduction, neuronal system and developmental biology. These aberrant processes are known to exacerbate tumour aggressiveness, invasion and metastasis. Furthermore, we observed 219 SNPs covering key gene regions such as those observed to be upregulated by SWATH-MS analysis. They include genes such as PALLD, AVL9, BPGM, SERPINB8 and MYPN. We have shown the dysregulation and simultaneous mutations of several key genes/proteins highlighting their roles as plausible biomarkers and therapeutic targets. Validation studies are required to confirm these results.

A review of adult resuscitative fluid purchasing and usage trends at an academic tertiary hospital in Johannesburg.

Intravenous fluid administration is a vital component in the resuscitation of critically ill patients. In recent years, there have been many studies to help guide which fluids should be used for resuscitation. Currently, it appears that the international trend is away from the use of colloids and unbalanced crystalloids and towards the use of balanced crystalloids. The aim of our study was to determine whether evolving international evidence has impacted resuscitative fluid practices in the Emergency Department (ED) and the Intensive Care Unit (ICU) in a tertiary hospital in South Africa. The study design was two-fold: a cross-sectional physician survey and a retrospective longitudinal observational study of the pharmacy fluid purchase records from the combined ED and ICU. Cross-sectional survey: in 2020 a doctor was 8.3 times more likely to choose a balanced crystalloid for resuscitation regardless of the clinical scenario over any other fluid (CI: 5.0-13.8). 55% of doctors surveyed agreed that their resuscitation fluid of choice had changed for a variety of reasons with the most popular reason cited as post-graduate education. Retrospective longitudinal observational study: throughout the study period, balanced crystalloids were the majority fluid purchased, although in ED lactated Ringers was the preferred balanced crystalloid and in ICU PlasmaLyte was preferred. Minimal colloids were purchased over the study period in declining amounts. Doctors working in a tertiary hospital in South Africa are following the trend of current evidence by using a balanced crystalloid as their resuscitation fluid of choice.

Knowledge, attitudes and practices of hospital-based staff regarding physical activity at a private hospital in Johannesburg

healthcare environment. The aim of this study was to determine the knowledge, attitudes and practices of private hospital-based staff regarding physical activity in Johannesburg. Methods: A cross-sectional study was conducted. Data were collected using a self-administered questionnaire. Data were analysed with a combination of descriptive and inferential statistics. A p -value less than 0.05 was deemed statistically significant. Results: A total number of 217 participants responded to the questionnaire. The majority of participants ( n = 179; 82.49%) displayed excellent knowledge of physical activity, had a good attitude towards physical activity ( n = 157; 72.35%) and displayed satisfactory practices ( n = 137; 63.13%). Participants with the highest level of education had better mean knowledge, attitude and practice scores as opposed to those with lower levels of education. There was a statistically significant difference amongst staff categories in terms of knowledge ( p = 0.004) and practice scores ( p = 0.031). In addition, there was a statistically significant difference amongst different levels of education in terms of knowledge ( p = 0.000), attitude ( p = 0.02) and practice scores ( p = 0.004). Conclusion: Staff members who participated in the study displayed only satisfactory physical activity practices. The hospital’s employee wellness programme should establish appropriate strategies to improve staff practices of physical activity in order to promote health.

An investigation into specialist practice nurses' knowledge of cardiopulmonary resuscitation guidelines in a tertiary hospital in Gauteng Province, South Africa.

Background Cardiac arrest is among the major causes of sudden deaths globally. Although out-of-hospital cardiac arrest occurs more commonly, in-hospital cardiac arrest is still a major health problem. Critical care areas provide care to critically ill patients who are at risk of cardiac arrest. It is important that nurses are knowledgeable and competent in cardiopulmonary resuscitation (CPR) in order to optimise the patient’s chances of survival and quality of life after cardiac arrest. Objectives To investigate specialist practice nurses’ knowledge of evidence-based guidelines for CPR Methods A descriptive cross-sectional survey was utilised. We sampled all critical care registered nurses (n=96) currently working in the adult emergency departments and intensive care units at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa. A self-administered instrument, the ‘evaluation questionnaire on CPR knowledge for health personnel from emergency services’ was used. Data were analysed using descriptive and comparative statistics. Results The mean CPR knowledge score was 46%. A score of 84% was considered adequate for a pass, and no respondents achieved this score. The majority of the respondents (80.85%; n=76) were specialists in the field of intensive care nursing. Conclusion The CPR knowledge of specialist practice nurses was suboptimal for the care required in high-risk settings. Further training is indicated. Contributions of the study We showed that specialist nurses working in critical care environments at a public hospital in Johannesburg scored poorly in a CPR knowledge test.

Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa.

IntroductionMental health problems are prevalent in adolescents living with HIV (ALHIV), often remain untreated, and may negatively affect antiretroviral therapy (ART) adherence and viral suppression. We implemented routine mental health screening at a paediatric ART clinic to improve the identification and management of mental health problems in ALHIV. In this report, we examine screening outcomes, associated patient characteristics and the odds of unsuppressed viral load in ALHIV screening positive for mental disorders.MethodsAdolescents aged 10 to 19 years attending Rahima Moosa Hospital in Johannesburg, South Africa between February 1, 2018, and January 1, 2020, were offered mental health screening at each routine HIV care visit. The screening included four pre‐screening questions followed by full screening (conditional on positive pre‐screening) for depression (Patient Health Questionnaire‐9 [PHQ‐9]), suicide (Adolescent Innovations Project [AIP]‐handbook), anxiety (Generalized Anxiety Disorder‐7 [GAD‐7]), post‐traumatic stress disorder (PTSD) (Primary Care PTSD Screen [PC‐PTSD‐5]) and substance use (CAGE Adapted to Include Drugs [CAGE‐AID]). We assessed screening outcomes and calculated adjusted odds ratios for associations between positive screening tests at the first screen and unsuppressed viral load (>400 copies/mL) at the measurement taken closest to the date of screening, within hundred days before and one day after screening.ResultsOut of 1203 adolescents who attended the clinic, 1088 (90.4%) were pre‐screened of whom 381 (35.0%) underwent full screening, 48 (4.4%) screened positive for depression (PHQ‐9 ≥10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD‐7 ≥10), 38 (3.2%) for PTSD (PC‐PTSD‐5 ≥3), 18 (1.7%) for substance use (CAGE‐AID ≥2) and 97 (8.9%) for any of these conditions. Positive screening for depression (aOR 2.39, 95% CI 1.02 to 5.62), PTSD (aOR 3.18, 95% CI 1.11 to 9.07), substance use (aOR 7.13, 95% CI 1.60 to 31.86), or any condition (aOR 2.17, 95% CI 1.17 to 4.02) were strongly associated with unsuppressed viral load.ConclusionsALHIV affected by mental health problems have increased rates of unsuppressed viral load and need specific clinical attention. The integration of routine mental health screening in paediatric ART programmes is a feasible approach for identifying and referring adolescents with mental health and adherence problems to counselling and psychosocial support services and if needed to psychiatric care.