Hospital In Town Research Articles

Fatigue-management strategies among women with endometriosis in South Africa: a qualitative study

Fatigue is a common, secondary symptom of endometriosis that has not been qualitatively explored. We conducted individual, face-to-face interviews with 25 women in South Africa about their experiences of endometriosis-related fatigue. Participants were recruited at a public hospital in Cape Town and through several South African endometriosis organizations. Interviews were conducted in English and Afrikaans and ranged from 30 min to 1 hr 16 min in duration. All interviews were audio recorded and transcribed. Interviews were analyzed using thematic analysis. We found that both the experience of fatigue and fatigue-management strategies were highly personalized. Participants reported using a variety of cognitive strategies, such as planning, pacing, and pushing through their fatigue to reduce the levels of fatigue. Participants also employed physical strategies such as rest, dietary changes, using supplements, and exercise. We found that while participants often tried fatigue-management strategies suggested to them by others, they struggled to maintain these strategies even when they were successful. There are currently no interventions aimed at reducing endometriosis-related fatigue. The findings of this study provide insight into the management of fatigue in women with endometriosis and may be used to develop a psychosocial intervention for fatigue among women with the disease.

The costing of operating theatre time in a secondary-level state sector hospital: A quantitative observational study.

There is no established costing model for operating theatres (OTs) in South Africa (SA), yet both health sectors have existing charges for OT time: in the state sector, Uniform Patient Fee Schedule (UPFS) rates, and in the private sector, rands per minute (ZAR/min) rates. Understanding the cost of providing the separate components of a health service is important for planning and funding purposes. To develop a costing model that would allow calculation of the ZAR/min cost of OT time. To determine the actual costs, in order to establish the comparable costs that would be included in the ZAR/min charges for OTs in the private health sector. The OTs in a secondary-level, state sector hospital in Cape Town were used in this quantitative observational study to develop a top-down costing model for OTs in SA. The inclusive costing model was developed in a consultative process with professionals, managers and experts from the state and private sectors. The model was then populated with costs for the month of August 2018. Costs were considered in the categories of full costs, shared costs, and capital or annualised costs. Owing to uncertainty in costing of OTs, two models - with different annualisation times assigned to the capital costs - were developed to demonstrate the difference. For shared costs, correction factors were determined using either an activity-based (workload) factor or a more generic estimation of workload using theatre nursing staff as a percentage of total hospital nursing staff.To determine a ZAR/min cost of creating a minute of available theatre time, all the annual costs were divided by minutes that the OTs are explicitly available, each year, to provide patient care. The model was then populated with costs using the appropriate correction factors. The longer annualisation model costed OT time at ZAR31.46 per minute, and the shorter annualisation model at ZAR33.77 per minute. In both the longer and shorter capital annualisation models, nursing was the largest contributor to costs at 36% and 33%, respectively, followed by construction costs at 9% and 11%, and then OT equipment at 8% and 11%. An inclusive, top-down costing model for OTs in SA was developed. This costing model will support work to develop costing for individual procedures and the appropriate charge for planned and emergency OT time, and to better determine budgeting for OT services. Meaningful critique of the model will improve its fidelity, and is likely to increase its utility, especially as SA moves towards universal health coverage.

Knowledge of danger signs in neonates among postnatal mothers of babies admitted in tertiary care neonatal intensive care unit in a two-tier town in South India

Background: Neonatal period is the first 28 days of life. Neonatal period is highly vulnerable and has high risk of mortality at an average global rate of 17/1000. Neonatal illnesses present with non-specific symptoms and signs. Neonatal danger signs signify common signs of severe illness. Aim of the study was to assess the awareness of postnatal mothers about danger signs in neonates and the associated factors.Methods: Facility based cross sectional study conducted at a tertiary care hospital in a two-tier town in South India. Source of population was postnatal mothers of babies who were admitted in NICU. A structured questionnaire was used to collect the data through face-to-face interview. Neonatal danger signs are signs that sick neonates show as stated by WHO, which includes- not able to feed, or stopped feeding well, convulsed or fitted since birth, fast breathing, chest in drawing, fever, cold to touch, yellow palms and soles, umbilical redness, or draining of pus, skin boils, or eyes draining pus, no or minimal movement when stimulated. Mothers who mentioned at least 3 are considered to have good knowledge.Results: Commonly mentioned danger signs are fever (89%), chest indrawing (59%), poor feeding (51%), and umbilical redness (48%). Mothers who had good knowledge was 32% of which 75.9% had counselling on danger signs during antenatal visits, 78% had antenatal visits more than 4,86.9% had post-natal care or visits,51.56% had education above secondary school.Conclusions: Mothers need counselling on neonatal danger signs during antenatal and post-natal visits to reduce neonatal mortality.

The effectiveness of a performance management system at a South African public hospital in Cape Town

Background: In 1994, South Africa instituted the Public Service Act of 1994 which is presumably applicable and must be adhered to by all public institutions. Because of the adoption of the Public Service Law, all employees employed in the Western Cape Government (WCG) are obligated to participate in the Performance Management System (PMS). Consequently, the authors were interested to know how the PMS performs and how employees respond to this system at a public hospital.Aim: The purpose of this study was to examine the processes of PMS to identify its effectiveness. Of uttermost significance, through the findings of the study, was to make recommendations that contribute to improving the implementation of PMS.Setting: The study is based at a public hospital to examine the effectiveness of a PMS at a South African public hospital. The hospital is situated in Cape Town, South Africa.Methods: In pursuing the study, the authors employed an exploratory research design. Consequently, a qualitative research method was applied.Results: The study discovered that the PMS at the hospital is ineffective to enhance the performance of the employees and achieve organisational goals.Conclusion: The system appears to be a great tool designed to measure the employees’ effectiveness. However, its implementation seems to suggest a need for a thorough investigation of its efficiency.

Knowledge, attitude and practice of patients with chronic diseases towards COVID-19 pandemic in Dessie town hospitals, Northeast Ethiopia

Background and aimsCorona virus disease-19 first detected in China, December 2019. The government of Ethiopia takes preventive measures but the number of peoples infected with COVID-19 has been increased. Control of the pandemic requires changing of knowledge, attitude and practice of people. Hence, the objective of this study was to assess chronic disease patients’ knowledge, attitude and practice towards COVID-19 pandemic. MethodsInstitution based cross-sectional study was done among 413 chronic disease patients from July 20 to August 5, 2020 in Dessie town hospitals. Multinomial logistic regression analysis was used and significant association declared at p-value of <0.05. ResultsFrom the total participants 34.6%, 81.4% and 40.7% had good knowledge, attitude and practice while 35.1%, 12.1% and 24.7% had moderate knowledge, attitude and practice towards COVID-19 pandemic, respectively. In multinomial logistic regression young age, urban residency, attainment of secondary education and presence of additional co-morbidity were predictors of moderate knowledge whereas urban residency, not attended formal education and presence of additional co-morbidity were predictors of good knowledge about COVID-19. Household family size and presence of additional co-morbidity were factors significantly associated with moderate practice of COVID-19 prevention methods. Furthermore, male sex, household family size, knowledge of COVID-19 and attitude towards COVID-19 were factors significantly associated with good practice of COVID-19 prevention methods. ConclusionSignificant number of chronic disease patients had poor knowledge and practice towards COVID-19. Therefore, government, health professionals, Medias, researchers and health institution should do to improve the gaps of chronic diseases patients.

Venous bicarbonate and creatine kinase as diagnostic and prognostic tools in the setting of acute traumatic rhabdomyolysis.

Myorenal or crush syndrome often develops following soft-tissue traumatic injury. It is a spectrum of disease that may result in severe renal dysfunction and kidney injury requiring renal replacement therapy. To review a large cohort of patients with so-called myorenal or crush syndrome and assess the biochemical markers of venous bicarbonate and creatine kinase as predictors for the development of acute kidney injury (AKI). All patients with myorenal syndrome who presented to Khayelitsha District Hospital, Cape Town, South Africa (SA), and Ngwelezana Hospital, Empangeni, KwaZulu-Natal, SA, between January and December 2017 were identified and reviewed. A total of 212 patients were included in the study. At both hospitals, 94% of the patients were male. Using the Pearson correlation coefficient, we compared creatinine kinase (CK) against serum creatinine. The mean CK level was 5 311.8 U/L and the mean creatinine level 133.457 μmol/L. The r-value was 0.2533. Although this is a technically positive correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000208. When comparing venous bicarbonate (HCO3) against creatinine, the mean HCO3 level was 22.296 mmol/L and the mean creatinine level 162.053 μmol/L. The r-value was -0.3468. Although this is a technically negative correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000013. The inverse ratio shown with HCO3 v. creatinine, although still a weak correlation, is significantly better in predicting an increase in creatinine compared with the weak positive correlation of CK v. creatinine. Although both venous HCO3 and CK showed a weak correlation with creatinine, the former performed significantly better in predicting AKI. In a resource-constrained system, we recommend that HCO3 be measured to assess patients with crush injury and that CK be regarded as a complementary modality.

Cerebral perfusion pressure and autoregulation in eclampsia—a case control study

Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] and 80.0 mm Hg [interquartile range, 67.5-92.0], respectively); furthermore, there was no difference in cerebral perfusion pressure between pregnant women with eclampsia and pregnant women with preeclampsia with severe features (109.5 mm Hg [interquartile range, 91.2-130.9] vs 96.5 mm Hg [interquartile range, 75.8-110.5]). Cerebral perfusion pressure and dynamic cerebral autoregulation are altered in eclampsia and may be important in the pathophysiological pathway and constitute a therapeutic target in the prevention of cerebral complications in preeclampsia.

A severity-of-illness score in patients with tuberculosis requiring intensive care

Background. We previously retrospectively validated a 6-point severity-of-illness score aimed at identifying patients at risk of dying of tuberculosis (TB) in the intensive care unit (ICU). Parameters included septic shock, HIV infection with a CD4 count &lt;200 cells/µL, renal dysfunction, a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F) &lt;200 mmHg, a chest radiograph demonstrating diffuse parenchymal infiltrates, and no TB treatment on admission. Objectives. To prospectively validate the severity-of-illness scoring system in patients with TB requiring intensive care, and to refine and simplify the score in order to expand its clinical utility. Methods. We performed a prospective observational study with a planned post hoc retrospective analysis , enrolling all adult patients with confirmed TB admitted to the medical ICU of a tertiary hospital in Cape Town, South Africa, from 1 February 2015 to 31 July 2018. The admission data of all adult patients with TB requiring admission to the ICU were used to calculate the 6-point severity-of-illness score and a refined 4-point score (based on the planned post hoc analysis). Descriptive statistics and χ 2 or Fisher’s exact tests (where indicated) were performed on dichotomous categorical variables, and t -tests on continuous data. Patients were categorised as hospital survivors or non-survivors. Results. Forty-one of 78 patients (52.6%) died. The 6-point scores of non-survivors were higher than those of survivors (mean (standard deviation (SD)) 3.5 (1.3) v. 2.7 (1.2); p =0.01). A score ≥3 v. &lt;3 was associated with increased mortality (64.0% v. 32.1%; odds ratio (OR) 3.75; 95% confidence interval (CI) 1.25 - 10.01; p =0.01). Post hoc , a P/F ratio &lt;200 mmHg and no TB treatment on admission failed to predict mortality, whereas any immunosuppression did. A revised 4-point score (septic shock, any immunosuppression, acute kidney injury and lack of lobar consolidation) demonstrated higher scores in non-survivors than survivors (mean (SD) 2.8 (1.1) v. 1.6 (1.1); p &lt;0.001). A score ≥3 v. ≤2 was associated with increased mortality (78.4% v. 29.3%; OR 8.76; 95% CI 3.12 - 24.59; p &lt;0.001). Conclusions. The 6-point severity-of-illness score identified patients at increased risk of death. We were able to derive and retrospectively validate a simplified 4-point score with superior predictive power.

Yield of CT angiography in penetrating lower extremity trauma.

CT angiography (CTA) has become a valuable tool in the assessment of suspected arterial injury in patients with penetrating lower extremity trauma. However, expensive imaging such as CTA should be judiciously utilized to ensure value-based care. We therefore assessed the yield of CTA in this setting at a level-1 trauma unit and correlated it with the clinical history provided. A retrospective descriptive study from 1 July 2013 to 31 June 2018 at a 1386-bed, tertiary-level, public-sector teaching hospital in Cape Town, South Africa.. All patients undergoing CTA for suspected arterial injury following penetrating lower extremity trauma were included. The imaging yield of clinically significant arterial injury and the predictive value of specific clinical signs were determined. A total of 983 patients (median age 27 years, 91% male) were included; 90% (886/983) had gunshots, 9% (89/983) stabs, and 1% (8/983) other injuries. Despite an average 13% year-on-year increase in CTA performed, there was no change in the proportion demonstrating arterial injury. Thirty-four percent (23/68) of patients with strong (hard) signs of arterial injury (active pulsatile bleeding, rapidly expanding hematoma, absent pulse, palpable thrill, or audible bruit), 11% (49/459) with moderate (soft) signs (history of an arterial bleed, excessive non-pulsatile bleeding, large non-expanding hematoma, major neurological deficit, diminished but appreciable pulse, and arterial proximity), and 5% (24/456) with no indication for imaging had clinically significant arterial injuries. Significant positive correlations were rapidly expanding hematoma (p = 0.009), an absent pulse (p < 0.001), and a diminished pulse (p < 0.001). Significant negative correlations were proximity to a major artery (p = 0.005) and no clinical indication provided (p < 0.001). There is poor correlation between clinical details provided and the presence of arterial injury at our institution. In this context, CTA serves a pivotal role in the definitive identification of arterial injury.

Cognitive impairment in preeclampsia complicated by eclampsia and pulmonary edema after delivery.

We aimed to assess cognitive function in women with preeclampsia stratified by severity, before and after onset of disease. Prospective study performed at a referral hospital in Cape Town, South Africa. Pregnant women between 20 and 42weeks of gestation with eclampsia, pulmonary edema and preeclampsia without severe features, and a normotensive pregnancy were approached. Women were included at diagnosis of preeclampsia or at admission for delivery (women with normotensive pregnancies). Two cognitive assessments, the Cognitive Failure Questionnaire to assess the cognitive function subjectively before inclusion in the study, and Montreal Cognitive Assessment to assess the current cognitive function objectively before discharge from the hospital after delivery, were performed. We included 61 women with eclampsia, 28 with preeclampsia complicated by pulmonary edema, 38 with preeclampsia without severe features, and 26 with normotensive pregnancies. There was no difference in cognitive function from early pregnancy between groups. Women with eclampsia and preeclampsia complicated by pulmonary edema scored lower on the Montreal Cognitive Assessment at time of discharge compared with women with normotensive pregnancies. The results were attenuated in pulmonary edema after adjustment for confounders. Women with preeclampsia complicated by pulmonary edema and in particular eclampsia had impaired cognitive function after onset of disease compared with women with normotensive pregnancies. The impairment did not seem to be present before onset of disease. Women with preeclampsia without severe features did not have impaired cognitive function.

A comparison between primary endorectal pull-through and staged procedures for patients with Hirschsprung’s disease

Background: Primary endorectal pull-through is becoming a standard of care across the globe. This study was done to compare the outcome of patients with Hirschsprung’s disease (HD) who underwent primary endorectal pull-through with patients who were treated with a staged approach. Methods: A retrospective data review was done of all patients diagnosed with Hirschsprung’s disease (HD) at Tygerberg Children’s Hospital, a tertiary hospital in Cape Town, during an 11-year period (2007 – 2018). The patients were divided into 2 groups: the primary Endorectal pull-through (ERP) group and the staged group and the two groups were compared. Results: Eighty patients with histologically confirmed Hirschsprung’s disease (HD) were seen at our institution during the study period (2007 – 2018). Four patients did not meet the inclusion criteria and were excluded. Of the remaining seventy-six who were included, forty-six patients (60.5%) had a primary endorectal-pull through (Primary group) and thirty patients (39.5%) had staged procedures (Staged group) with a stoma before the final ERP. The peri-operative complications were subdivided into major and minor complications. Minor perioperative complications in the primary group were less (13%) compared to the staged group (33%) with a p-value of 0.017, making the difference statistically significant. Anastomotic strictures were the most common complication in both groups with abdominal wound infection being more common in the staged group. The late complications were similar in both groups with a p-value of 0.43. Constipation was the most common complication in both groups, followed by soiling. Conclusion: The two groups had a similar outcome without statistically significant differences. We can safely conclude that the primary endorectal pull-through for HD is at least as safe as the staged approach in Sub- Saharan Africa. With this technique, we avoid a stoma and the necessity for two surgical procedures with added potential complications.

Outcomes of patients with thoraco-abdominal gunshot wounds operatively managed at a district hospital in Cape Town, South Africa.

AimTrauma is a leading cause of morbidity and mortality in the first four decades of life. Thoracoabdominal gunshot wounds carry a significant risk of mortality. This risk of death is reduced if patients are managed in dedicated units. This study examines the outcome of these patients managed in a district level hospital.MethodIn this retrospective review, patients with thoracoabdominal gunshot wounds were identified from operating room registry for the period of January 2015 to December 2018. Data was collected retrospectively from folders and analysed for the primary outcome of mortality.ResultsSixty-eight thoracoabdominal gunshot wounds were managed operatively over the period described. Only six patients were female. The median age was 29.5 years. Fourteen patients required postoperative transfer to a level 1 trauma unit. Thirteen patients died, nine at the district hospital and four at the level 1 unit. Significant differences in organ injuries were noted in the patients that died compared to the survivors.DiscussionThe in-hospital mortality rate of patients managed at the district hospital was 13.2% which is comparable to international rates of 12–18%. However, the subset of patients that required postoperative transfer to a level 1 trauma unit had a high mortality rate of 28.6%. The DH is committed to managing unstable and unresponsive patients once they present. Improved mortality rates will only occur with better prehospital transport policies and by equipping the DH to manage these patients postoperatively.ConclusionManagement of these patients can be successful at a district hospital. However, significant obstacles exist to their optimal care, as demonstrated by the high mortality patients requiring postoperative transfer.

The incidence of maternal hypoglycaemia with prolonged fasting before elective caesarean section

Background: Both national and international guidelines recommend that parturients fast from solids and clear fluids for six and two hours, respectively, prior to a caesarean section (c-section) in order to reduce the risk of pulmonary aspiration. The objective of this study was to evaluate whether fasting times conform to the current American Society of Anesthesiologists’ (ASA) recommendations and whether prolonged fasting times are associated with metabolic sequelae, namely hypoglycaemia and ketonuria. Methods: A total of 56 parturients were enrolled and interviewed at Tygerberg Hospital, a tertiary referral hospital in Cape Town, South Africa. Women who were unable to provide consent (below the age of 18) and/or women who were not scheduled for an elective c-section were excluded from the study. Whole blood glucose and urine ketone levels were measured immediately before anaesthesia. Results: Fasting times for solids and fluids were 15 hours (IQR 12–18; 95% CI 14–17) and 14 hours (IQR 11–16; 95% CI 12–15), respectively. During the preceding week, 32% of the participants were subjected to repeated fasting periods with a median cumulative time (all the fasting periods added) of 40 hours (IQR 35–64; range 28–133). Hypoglycaemia occurred in 39.3% (95% CI 26.8–53.3) and significant ketonuria occurred in 51.8% (95% CI 38.1–65.1) of the participants, with both conditions associated with longer fasting times (p < 0.001). A sigmoid relationship was observed between fasting time and the probability of hypoglycaemia. Hypoglycaemia was unlikely to occur before nine hours of fasting, and thereafter, the risk of hypoglycaemia increased 1.5-fold per hour (95% CI 1.2–1.8). Conclusion: Fasting times before an elective c-section were longer than what is recommended by the ASA guidelines and were associated with statistically and clinically significant metabolic consequences. Maternal glucose should be checked after nine hours of fasting, since the incidence of hypoglycaemia exceeds 5% after nine hours of fasting. Adherence to outdated fasting practices should also be addressed. Fasting time may be a simple, useful healthcare quality indicator.

Juvenile ossifying fibroma of the maxillofacial region: analysis of clinico-pathological features and management.

Background The diagnosis and management of juvenile ossifying fibroma (JOF) remains a highly debated topic with paucity of studies with long-term follow-up, hence the aim of this study was to report on the clinico-pathological features and management of these neoplasms.Material and Methods A retrospective analysis was performed on all histopathologically confirmed JOF presenting at two tertiary hospitals in Cape Town, South Africa over a period of 39 years. Clinical, demographic, histopathological and radiological features were analyzed. Surgical methods were documented and a minimum post-operative follow-up of 12 months was a prerequisite.Results Seventeen patients met the inclusion criteria and were included in this study. Overall, the ages of patients ranged from 3–31 years (mean= 13 years) with male to female ratio of 1.8:1. The ages of patients diagnosed with Trabecular JOF were significantly younger than patients with Psammomatoid JOF (P = 0.01). The majority of patients presented with marked swelling (88.2%). Interestingly, most neoplasms occurred in the mandible (76.5%) with all Psammomatoid JOF uncharacteristically occurring in the mandible. There was only one case of Trabecular JOF occurring in the sinonasal area. Most neoplasms appeared as unilocular (76.5%) and well-defined (82.4%) with mixed radio-density (70.6%) on radiographs and computed tomography. Curettage with peripheral ostectomy was shown to be the least invasive method with an accepTable recurrence rate (10%). Six lesions underwent resection without any recurrences however caused high morbidity to these young patients.Conclusions The high number of lesions occurring in the mandible for both variants of JOF demonstrates that site should not be a major determining factor in the diagnosis of JOF. Moreover, curettage with peripheral ostectomy should be used as the first line of management to minimize morbidity to the patient and that resection should be reserved for large and recurrent lesions. Key words:Juvenile ossifying fibroma, juvenile trabecular ossifying fibroma, juvenile psammomatoid ossifying fibroma, fibro-osseous lesions, maxillofacial region, multi-centre study.

Amoxicillin Utilization Pattern at Governmental Hospitals in Eastern Ethiopia.

IntroductionPenicillin is among the highly used antibiotics in most parts of the world, with amoxicillin being the most frequently utilized drug in the category. However, amoxicillin use has been found to deviate from standard treatment guidelines (STGs).ObjectiveThis study aimed to evaluate amoxicillin utilization patterns based on Ethiopian STGs criteria at four governmental hospitals in Harar town: Hiwot Fana Specialized University Hospital, Jugel Hospital, South East Command III Hospital, and Federal Harar Police Hospital in Eastern Ethiopia in 2016.MethodsA hospital-based retrospective cross-sectional study was employed using medication records of patients who received amoxicillin in 2016 at four governmental hospitals from May 15 to June 30, 2018. A total of 502 medication records were proportionally allocated based on the ratio of consumption data of each hospital. Simple random sampling was employed to collect the required sample from the sampling frame. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis.ResultsAmoxicillin was used in all age groups, including pregnant and lactating women. The majority (96.2%) of patients were from the outpatient departments. Complete blood count was the most laboratory investigation carried out in 24.9% whereas microbiological culture was not recorded at all. Top three indications include nonspecific upper respiratory tract infections (15.1%), pneumonia (13.5%) and dental problems (10.6%). Non-steroidal anti-inflammatory drugs (56.2%) were frequently co-administered agents. An appropriate utilization was made considering indication, dose, frequency and therapy duration in 23.9% as per the Ethiopian STG. The wrong indication (65.4%) was the prime reason for inappropriateness, followed by dose (14.6%) and duration of therapy (12.2%).ConclusionAmoxicillin utilization was appropriate in less than a quarter of patients. The wrong indication was the main reason for inappropriateness, predisposing to resistance development. Further studies identifying factors related to misuse and sensitivity tests should be the next steps.

The appropriateness of ceftriaxone utilization in government hospitals of Eastern Ethiopia: A retrospective evaluation of clinical practice.

Introduction:Drug use evaluation is a method of obtaining information to identify problems related to drug use and if properly developed, a means of correcting the problems. Ceftriaxone is among the most commonly utilized cephalosporins. Owing to a broad spectrum of activity and being used empirically, ceftriaxone has been used inappropriately posing a risk for development of antimicrobial resistance. This study is, therefore, designed to evaluate the appropriateness of ceftriaxone utilization in government hospitals in Harar town.Methods:A retrospective cross-sectional study was conducted in four government hospitals of Harar town by reviewing the medical records of 271 patients who received ceftriaxone from 1 January to 31 December 2016. Systematic random sampling was utilized to capture the medical records. Data were entered and analyzed using SPSS version 22.Results:From the 271 medical records reviewed majority of patients were from surgical ward (n = 85, 31.4%) followed by gynecology and obstetrics ward (n = 67, 24.7%). Demographically, the majority of the patients were female (n = 142, 52.4%). Patients in the age group of 20–29 years were dominant (n = 98, 36.2%). A total of 71 drugs were co-administered with ceftriaxone, the most common being metronidazole followed by tramadol. Among the co-administered drugs, unfractionated heparin (n = 6), warfarin (n = 5), and enoxaparin (n = 1) were found to have a moderate drug interaction with ceftriaxone. Ceftriaxone was commonly used for post-operative prophylaxis (n = 80, 27.5%) followed by for the management of pneumonia (n = 62, 21.3%). The result of ceftriaxone use evaluation showed that majority (n = 190, 70.1%) were found to be inappropriate. The inappropriate utilization was primarily due to wrong indication (indications for which ceftriaxone was not the primary option) (n = 114, 60.0%) followed by wrong duration (n = 54, 28.4%).Conclusion:Ceftriaxone was used inappropriately in more than two-thirds of the patients, with wrong indication and wrong duration contributing the majority. Inappropriate use of antibiotics may potentially lead to the emergence and spread of drug-resistant microorganisms and also ultimately exposes the patient to treatment failure, prolonged hospital stay, and higher cost of therapy.

Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures - A multi-observer study.

Introduction: Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. Methods: Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. Results: The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. Conclusion: Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.

"We communicate poorly with each other" - Registrars' perceptions of communication skills training.

This article was migrated. The article was marked as recommended. Background There is strong evidence that patient health outcomes are improved by effective clinician communication both with their patients and each other. Despite this, there is still a lack of training in and assessment of communication skills in postgraduate curricula in South Africa. When designing a communication skills training curriculum for registrars, their views and needs should be considered as they may impact the effectiveness of such an intervention. Objectives To explore registrars' understanding of what constitutes effective communication in the workplace and the value thereof. Furthermore, the registrars' communication skills training experiences and needs were determined. Methods This was an exploratory qualitative study conducted at a government hospital in Cape Town, South Africa. Registrars' perceptions were explored making use of one on one interviews that were transcribed, coded, and themed using an inductive, iterative approach. Results Ten registrars working in the Department of Obstetrics and Gynaecology were interviewed individually. Registrars highly value effective communication skills and are of the opinion that they can improve with training. The participants experienced challenges when communicating with colleagues, particularly with consultants. The registrars made recommendations for the improvement of communication skills training at postgraduate level. Conclusion Registrars expressed a need for formal training to facilitate effective communication with colleagues, especially with consultants. These results should be considered when developing a postgraduate curriculum for communication skills training. Enhancing the quality of registrar-consultant interactions may have a positive influence on both the standard of patient care and registrars' clinical learning environment.

Magnitude of death and associated factors among road traffic injury victims admitted to emergency outpatient departments of public and private hospitals at Adama Town, East Shewa Zone, Ethiopia.

Objectives:Road traffic injuries, disabilities, and deaths have been a major public health problem worldwide and in Ethiopia. Globally, around 1.35 million people die every year on the roads and 20–50 million sustain nonfatal injuries as a result of road traffic crashes. This study aimed to assess the magnitude of deaths and associated factors among road traffic injury victims admitted to emergency outpatient departments of public and private hospitals at Adama town, East Shewa Zone, Ethiopia.Methods:Institution-based cross-sectional study was conducted among 381 road traffic injury victims admitted to hospitals in Adama town, East Shewa, Ethiopia, from 14 December 2019 to 29 February 2020. Data were collected using interviewer-administered structured questionnaires. Data were entered into EpiData version 4.6.0.2 and analyzed using SPSS version 21. Bivariable and multivariable logistic regressions were fitted to identify variables significantly associated with road traffic injury–related deaths and the results were presented with adjusted odds ratios and 95% confidence interval. Statistical significance was declared at p-value < 0.05.Results:The magnitude of deaths among road traffic injury victims were 12.9%. Age (25–44 years) (adjusted odds ratio = 4.24, 95% confidence interval = 1.70–10.61), rural resident (adjusted odds ratio = 2.26, 95% confidence interval = 1.11–4.55), pedestrian (adjusted odds ratio = 3.72, 95% confidence interval = 1.67–7.99), night-time injury (adjusted odds ratio = 5.29, 95% confidence interval = 2.52–11.10), injuries on weekends (adjusted odds ratio = 2.32, 95% confidence interval = 1.12–4.80), not getting first aid at injury site (adjusted odds ratio = 2.64, 95% confidence interval = 1.02–6.84), and known comorbidity conditions (adjusted odds ratio = 3.01, 95% confidence interval = 1.23–7.38) were significantly associated with road traffic injuries–related deaths.Conclusion:A significant proportion of road traffic injuries resulted in death. Age, place of residence, pedestrians, night-time injury, and not getting first aid were associated with road traffic injuries–related deaths. Preventive strategies that focus on young adults, rural residents, pedestrians, and people with comorbidities would minimize road traffic injuries–related deaths. Moreover, strict supervision on weekend and night-time drives, and providing accessible lifesaving first aid services would have significant importance.

Radiation-induced pathological fractures of the proximal femur: a case series considering an endoprosthetic solution

ABSTRACT BACKGROUND: Radiation-induced pathological fractures of the proximal femur are difficult to treat due to frequent non-union and hardware failure using standard fracture fixation techniques. This case series investigates endoprosthetic replacement as a treatment option METHODS: A retrospective folder review from a private hospital in Cape Town, of patients who had sustained a radiation-induced pathological fracture, was reviewed using descriptive statistics. RESULTS: Six patients met the inclusion criteria. One patient was excluded as the minimum follow-up time of six months was not met. Of the Ave patients that were analysed, all Ave sustained transverse, subtrochanteric femur fractures. Prior to definitive treatment with a proximal femoral replacement, three patients were treated with standard trauma instrumentation prior to referral to the unit, and one patient was treated with a vascularised fibular graft as their initial treatment while at the unit. One patient was treated with an endoprosthetic replacement as their first procedure at the unit. Among the three patients treated with standard trauma fixation and the one patient treated with a vascularised fibular graft, there was a 100% failure rate. One standard trauma instrumentation patient had an ablation due to free musculocutaneous flap failure and periprosthetic infection after endoprosthetic replacement. This was the only complication of endoprosthetic replacement. At a median follow-up of 15 months (min 7, max 55) the median Musculoskeletal Tumour Society score was 74% (min 63%, max 93%. CONCLUSION: This case series seeks to highlight the high failure rates seen when treating this condition with standard trauma instrumentation or biological methods. Further research is needed, but endoprosthetic replacement may be a viable alternative solution Level of evidence: Level 4. Keywords: radiation-induced fracture, pathological fracture, endoprosthetic replacement