Private Hospital Group Research Articles

THE PAYMENT FOR AN ORGAN AND THE ADMISSION OF GUILT BY A SOUTH AFRICAN HOSPITAL The State v Netcare Kwa-Zulu Natal (Pty) Ltd – Agreement in terms of section 105A(1) of the Criminal Procedure Act 51 of 1977, Netcare Kwa-Zulu (Pty) Ltd and the State, Commer

As the first of its kind in plea bargaining, a South African private hospital group pleaded guilty on charges of trafficking in human organs. The Commercial Crimes Court of the Kwa-Zulu Regional Court (a Specialised Unit of the National Prosecuting Authority of South Africa) made an order in November 2010 in terms of which Netcare Kwa-Zulu (Pty) Ltd (Netcare) entered into a plea and sentence agreement with the state whereby Netcare pleaded guilty to 109 counts related to charges of illegal kidney transplantoperations. Charged with the St Augustine’s Private Hospital in Durban were the parent company Netcare (Pty) Ltd, its Chief Executive Officer, Richard Friedland, and eight others: four transplant doctors, a nephrologist, two transplant administrative co-ordinators, and a translator. The admission of guilt by the group relates to illegal kidney transplants which took place between June 2001 and November 2003 whereby Israeli patients in need of kidney transplants were brought to South Africa for such transplants to be performed at St Augustine’s Private Hospital. The kidneys were bought from Romanian and Brazilian citizens who were willing to sell their organs.

Effects of demographic, occupational, and practice environment variables on organizational silence among nurse managers.

To define nurse managers' organizational silence behaviors and examine the demographic, occupational, and practice environment factors that may influence their silence. Organizational silence is affected by organizational structures, policies and procedures, team structures, and practice environments. Whether nurse managers' behaviors affect the organizational silence and practice environment in particular has not been thoroughly studied. This cross-sectional study was conducted using an online survey of 169 nurse managers working in a group of private hospitals in Turkey. Data were collected using the Nurse Manager Practice Environment Scale, the Organizational Silence Behavior Scale, and a questionnaire with 16 sociodemographic and job-related questions, and descriptive statistics, correlations, and regression analyses were used to analyze the data. Nurse managers exhibited acquiescent silence and silence for the protection of the organization. There was a negative correlation between scores on the two scales. Regression analysis showed that nurse managers' organizational silence was affected by the two subscales of nurse managers' practice environment and the ability to express opinions openly. Positive work environment and being able to express opinions comfortably decrease the level of organizational silence of nurse managers. In order to reduce organizational silence behaviors, along with open-door policies and a corporate culture where ideas can be expressed freely, health institutions should implement measures to ensure a positive work environment that empowers administrative leaders to create a culture of patient safety and culture of generativity. Regulating the roles and responsibilities of nurse managers at the institutional level and implementing appropriate nursing laws and regulations at the national level will facilitate changes to improve their management practices.

Analysis of Causes of Hospitalization Among Children with Sickle Cell Disease in a Group of Private Hospitals in Jeddah, Saudi Arabia.

PurposeSickle cell anemia (SCA) is a chronic hematologic condition that requires frequent hospitalization representing a significant economic burden on the health services. The aim of this study was to explore the causes and underlying factors of hospitalization among children with SCA, as well as the factors affecting their length of hospital stay.Patients and MethodsThis retrospective study included children and adolescents less than 16 years old who were admitted in a group of private hospitals in Jeddah, Saudi Arabia, during the period from January 2018 to December 2019.ResultsA total of 94 patients were included in this study, 59.6% were males, with a mean age 7.29 ± 3.82 years. The majority of the patients (91.5%) had sickle cell disease. The most common cause of hospital admission was vaso-occlusive crises (VOC) (64.9%) followed by infection (24.5%), acute chest syndrome (ACS) (18.1%), and acute hemolytic crisis (12.8%). We found no significant difference between gender and different causes of admissions (p > 0.05). While in relation to age group, limb pain and back pain were found to be significantly more frequent among children ≥ 7 years old (p = 0.03,0.04), while infections were significantly more frequent among children < 7 years old (p = 0.003). We analyzed the length of hospital stay and different factors, and we found that the mean length of hospital stay was significantly higher among children who were admitted with infections (p = 0.01) and ACS (p < 0.001) and among children who are non-compliant on hydroxyurea (p = 0.04).ConclusionThe most common cause of hospitalization among children with SCD in Jeddah, Saudi Arabia, was VOC followed by infection, ACS and acute anemia. The length of hospital stay was more prolonged among children with infection and ACS, as well as children who were non-compliant to hydroxyurea.

Editorial introductions.

Editorial introductions.

An audit of published South African diagnostic reference level data

Diagnostic reference levels (DRLs) are accepted as a dose optimisation tool for patients undergoing x-ray imaging and are required by South African (SA) legislation for 26 fluoroscopically guided procedures (FGPs). The aim of this paper is to collate all published SA data on DRLs in preparation for a project to establish national DRLs. Systematic searches were conducted of various applicable databases. All research that proposed DRLs for any imaging procedure in South Africa was included. Twenty-one works met inclusion criteria, the earliest from 2001. Two-thirds of all work reported on FGPs and five studies documented computed tomography DRLs. Three publications focussed exclusively on paediatric imaging DRLs. No studies on mammography or dental radiography were found. For clinical procedures with more than one proposed DRL, the range of proposed DRL varied by up to a factor of five. The highest proposed DRL is 373.1 Gy cm2 for endovascular aneurysm/aortic repair procedures. Data were collected in six public hospitals and two private hospital groups. Thirty-six authors contributed to the manuscripts, but only six studies had an inter-disciplinary authorship. This is the first paper to provide a comprehensive review of SA DRL data and thereby advances international radiation protection initiatives. The data suggests there is room for more interdisciplinary work and that there must be rigorous standardization of reported parameters and data collection. This audit also highlights the need for standardized terminology, particularly for FGPs.

Antimicrobial prescribing in the surgical and medical wards at a private hospital in KwaZulu-Natal, South Africa, 2019.

Appropriate antimicrobial use is imperative owing to the misuse of antimicrobials, which has resulted in a growing burden of antimicrobial resistance. Evidence-based guidelines should be adhered to in order to ensure the sustainability of effective antimicrobials. To assess the appropriateness of antimicrobial prescribing at a private hospital in Durban, KwaZulu-Natal, South Africa. The records of patients admitted to the surgical and medical wards over a 2-month period were reviewed to assess the choice, dose and duration of prescribed antimicrobials. The guidelines used to determine the appropriateness of the prescriptions were: the Standard Treatment Guidelines and Essential Medicines List for South Africa - Hospital Level Adults, 2015 edition, the antimicrobial indications and prescribing instructions in the South African Medicines Formulary, the South African Antibiotic Stewardship Programme guidelines and the evidence-based surgical prophylaxis guidelines adopted by the hospital group where the research was conducted. During the study period, 466 patients were admitted and prescribed an antimicrobial, of whom 220 (47.2%) were admitted to the surgical ward and 246 (52.8%) to the medical wards. A total of 779 antimicrobials were prescribed. Of the 660 antimicrobials prescribed for empirical treatment, 305 (46.2%) were appropriately prescribed based on drug choice, dose and duration. Of the 38 antimicrobials that were classified as targeted, 36 (94.7%) were prescribed at the correct dose and 33 (86.8%) for the correct duration. Of the 81 antimicrobials prescribed for surgical prophylaxis, only 32 (39.5%) met the criteria for appropriateness in terms of drug choice, dose and duration. Our findings suggest that compliance with evidence-based guidelines for the use of antimicrobials is not optimal in hospitals in the private sector. Antimicrobials are prescribed inappropriately for empirical treatment and for surgical prophylaxis. Private hospital groups should consider adopting antimicrobial prescribing guidelines that are mandatory for doctors to adhere to in order to promote rational antimicrobial prescribing, and thereby reduce the burden of antimicrobial resistance.

Labour epidurals in Gauteng Province, South Africa

Background. Inadequately controlled labour pain is associated with numerous deleterious physiological and psychological effects. Epidural labour analgesia is accepted as the gold standard. Objectives. To establish the frequency of labour epidural analgesia for vaginal and caesarean section delivery in Gauteng Province (GP) private and public hospitals. Methods. GP maternity hospitals belonging to the three largest private hospital groups, and public academic, tertiary, regional and district maternity hospitals, were approached for inclusion in the study. A total of 24/47 private hospitals and 21/26 public hospitals agreed to participate in the present study and data from these hospitals were included in the data analysis. This was a retrospective study, and the delivery statistics and registers for 2015 were examined from all participating hospitals. Consecutive convenience sampling was applied. Results. A total of 3 560 labour epidurals were placed in the 45 participating hospitals in GP in 2015. About two-thirds (62%; n =2 208) of these labour epidurals were placed in the private sector. The median (interquartile range (IQR)) annual epidural frequency for all participating private hospitals was 6% (1.37 - 8.42). Only two public hospitals in GP were able to offer labour epidural services in 2015 and the annual proportion of deliveries with epidural placement was 4.1%. Both hospitals were academic hospitals affiliated with a single university. Conclusion. Similar to other developing countries, the labour epidural rates in GP hospitals were well below international labour epidural rates in 2015. This lack of service provision may be compromising patient care as well as the training of healthcare professionals.

A COMPARATIVE STUDY BETWEEN GENERAL AND SPINAL ANESTHESIA REGARDING MATERNAL BLOOD INDICES CHANGES AFTER LOW RISKY ELECTIVE CEASAREAN SECTION (A PROSPECTIVE CONTROLLED RANDOMIZED STUDY)

ABSTRACT Background: Delivery by ceasarean section is one of the most common surgical procedures nowadays. However, Choosing of anesthesia is a matter of controversy among obstetrician. Objective: To study the effect of two types of anesthesia on maternal hemoglobin and hematocrit level after elective cesarean section. Patients and methods: This was a randomized controlled study done at Sayed Galal University hospital and private centers (Tbarak Private Hospital Group) including 100 pregnant women underwent elective first time ceasarean section for variables causes. Changes in maternal hemoglobin and hematocrit indices were measured. Result: There was statistically significant difference between both groups after 48th hour post ceasarean section. Mean 48 hours postoperative hemoglobin and hematocrit parameter differences were significantly lower in the group with spinal anesthesia. Conclusion: Spinal anesthesia was better and has a greater advantage for maternal condition than general anesthesia as regard post-operative blood indices changes. So, whenever it is not contraindicated, spinal anesthesia should be recommended for elective ceasarean section.

Biotronik: bypassing the commodity trap of medical devices in South African healthcare

Learning outcomes The learning outcomes of this paper is as follows: to analyse the drivers, mediators and threats of commoditisation. To critically evaluate the merits of different marketing options that may be employed to avoid commoditisation. To critically assess the branding-focussed or customer-focussed strategies that could be used. To develop appropriate strategies for Biotronik SA to counter commoditisation in the future. Case overview/synopsis The case begins with the protagonist and managing director of Biotronik SA, Robbie Nel, brewing over a new industry development. One of the leading private hospital groups has sent an open invitation to medical device suppliers to tender, where the lowest-priced products will win shelf space in their cathlabs. Robbie has to decide whether to sacrifice Biotronik SA’s profit margins to win the tender or risk not being stocked in their cathlabs. Or, he must find an alternative non-price-based strategy to pursue. The medical device industry is facing increasing price pressures from various stakeholders in the device-purchasing process. The decision to purchase is no longer the responsibility of specialist physicians alone. International and local market trends indicate that the medical device industry is threatened by commoditisation. Robbie has to make a decision on changing the Biotronik SA business model and strategy in response to these macro trends. Complexity academic level This teaching case is aimed at postgraduate students, particularly those pursuing MBA, EMBA and Postgraduate Diploma programmes, as well as specialist masters and executive education. The students should have some work experience to comprehend and assess the case from a practical perspective. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes. Subject code CSS 8: Marketing.

Pediatrics in Rural Regions Caught between Thrift and Ensuring Adequate Healthcare Provision

On the basis of the current hospital financing system, the economically viable operation of small departments is hardly possible. Ensuring the availability of medical specialists "round the clock" in these departments leads to high fixed costs. Remuneration through the diagnosis-related system is currently calculated using the cost accounting of specialized service providers and large clinics. In contrast to the smaller departments providing basic care, the maintenance of basic services represents only a smaller percentage of costs for large facilities.There are legal and economic limits to the political influence on the hospital financing system. If adequate provision of healthcare is at risk, takeover of a private hospital by the local authority can be considered under certain conditions. In addition to quality indicators, the municipal subsidiarity principle must be complied with in a takeover of a hospital. Even under municipal sponsorship, work must be done to ensure economic efficiency. It is questionable whether a municipal authority can achieve greater efficiency than a large private hospital group. A possible consequence would be a reallocation of costs to the society. While maintaining current hospital funding, small hospitals in rural areas are at a disadvantage. Personnel shortages exacerbate the situation. With the mechanisms of the free market, it cannot be assumed that private hospital operators have an increased interest in the operation of appropriate clinics. A (re) municipalization with the same financing model will probably not make it more economical to operate, but appears to be an option for political reasons. Changes to the hospital financing system are required if further disadvantages to rural areas or reduction in healthcare provision are to be counteracted.

Determining the Attitudes of Nurses Working in a Private Hospital Group Towards the Employment of Internationally Educated Nurses

Determining the Attitudes of Nurses Working in a Private Hospital Group Towards the Employment of Internationally Educated Nurses

Electronic phenotyping of heart failure from a national clinical information database

Abstract Introduction A database of clinical information collected from several medical institutions, including national university hospitals and private hospital groups, and the medical information database network, MID-NET, have been available to the public in Japan since 2018. To analyse clinical events, i.e., to perform electronic phenotyping, it is important to extract data from clinical information correctly, combine multiple pieces of information, and define the target disease. Herein, we investigated a study to find patients with heart failure and validated our findings using MID-NET data. Methods A criterion to describe heart failure cases was determined according to clinical guidelines released by the Japanese Circulation Society. The data studied were based on records from April 1–December 31, 2013. The initial rule was based on disease names, examinations, and medications pertaining to heart failure. We extracted and analysed clinical data from MID-NET and found patients with heart failure. Two doctors, including a cardiologist, reviewed the medical records and verified the legitimacy of the cases, following which we calculated precision and recall rates. Next, we examined a method to identify factors to extract true cases correctly using machine learning with XGBoost in R. Results A total of 5,282 cases extracted via disease names were related to heart failure. Of these, 2,799 cases corresponding to the initial rule were retrieved, and 200 cases were randomly sampled and assessed. A total of 70 cases were found to be true. Thus, a precision rate of 0.350 and a recall rate of 0.912 were determined. A machine learning method revealed the correlation of heart failure with several factors, including the serum b-type natriuretic peptide (BNP) value, link between commencement date of the disease and actual hospitalization date, and medications for the treatment of heart failure. Using this data, we could determine the conditions contributing to improving the validity of the cases with heart failure. In this manner, patient cases were extracted using the disease name as it is related to heart failure and hospitalisation within two weeks after the commencement date of the disease. Furthermore, the candidates were categorised into three groups according to serum BNP values (high, middle, and low ranges). The high group was labelled “heart failure”, and the low group was excluded. In the middle group, candidates were additionally categorised according to their prescribed medication for heart failure. Our analysis indicated that the precision rate increased to 0.878 while the recall rate decreased to 0.697. The F-measure also increased from 0.506 to 0.777. Conclusions To find target cases from a large clinical database, precise electronic phenotyping is required. A machine learning method can enable accurate identification of patients with heart failure. Leveraging large amounts of clinical data may be beneficial for medical research progress. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development

Temperature modifies the association between air pollution and cardiovascular disease hospital admissions in the Vaal Triangle Air Pollution Priority Area, South Africa

Background: Very few studies in Africa investigated effect modification by a temperature indicator (e.g. apparent temperature, Tapp) on the human health effects of air pollution. Due to climate change, an increase of 3-4°C in ambient temperature is projected along the South African coast and 6-7°C inland during the next 80 years. Methods: Cardiovascular disease (CVD) hospital admission data (ICD10 I00-I99) were obtained from a private hospital group; after ethics approval. The study period was 1 January 2011 to 31 October 2016. NO2, SO2, PM2.5, PM10, temperature and relative humidity data were obtained from the Department of Environmental Affairs. A case-crossover epidemiological study design was applied. The present study focused on lag0-1; as most other studies. Models were adjusted for public holidays and Tapp. Days with Tapp below and above/equal the 25th (9.6°C) and 75th percentiles (20.1°C) were classified as cold and warm days, respectively. Results: Of the 15 237 admissions, 45.9% were from women and 39.0% from 15-65 year olds. The daily NO2, SO2, PM2.5 and PM10 levels were 30.3, 17.1, 35.4 and 60.8 μm/m3, respectively, and exceeded the WHO guidelines between 25% to 50% of the days. None of the air pollutants had significant associations with CVD admissions on cold or warm days. The elderly appeared to be more at risk to PM10 on normal days compared to all groups combined, e.g. RR 1.037 95%CI 1.009-1.065 per 10 μm/m3 increase compared to the unstratified analyses RR 1.017 95%CI 1.001-1.035. The same was observed for males RR 1.026 95%CI 1.003-1.050. PM2.5 had a stronger association than PM10 among the elderly on normal days: RR 1.068 95%CI 1.008-1.133. Conclusions: These results indicate that the risk of CVD admissions due to ambient air pollution exposure is different on cold, normal and warm days in Cape Town.

Internal Validation Process of Health Care-associated Infections (HAI) Data in a Group of Private Hospitals from Brazil

Background The primary goal of health care-associated infections (HAI) surveillance is to identify and measure the progress towards achieving the lowest number of infections. Assessing the accuracy of reporting data using independent validation is critical to this goal. In 2018, with a perspective of strengthening the patient's quality and safety strategies, one group of 21 general private hospitals in Brazil were updated the system of reporting data of HAIs including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (PAV). These data began to be manage by a corporate infection control team. Aim: to test the accuracy of HAI rate, notified by a group of private hospitals in Brazil. Methods Based on NHSN diagnostic criteria HAIs, all infections notified in 21 hospitals from five different states in Brazil was validate by four Infection Control Preventionists (corporative team). The validation process included a systematic retrospective chart review associated with the analysis of positive cultures over a period of five months (August to December 2018). Results 1357 cultures was evaluate of which 1314 (97%) met the NHSN definition for HAI. The HAI compliance rate separated by topography was: CLABSI 96%; CAUTI: 86% and PAV: 96%. Components of the case definition that were a source of misinterpretation included the following: CLABSI – misinterpretation of NHSN criteria between primary and secondary bacteremia, and differentiation regarding laboratory-confirmed bloodstream criteria 1 (recognized pathogen) and criteria 2 (skin contaminant); PAV - pneumonia cases notified only by clinical and non-epidemiological definition; CAUTI – reports of asymptomatic bacteriuria. Conclusions The data of the hospitals studied are generally reliable. However, this study shows the need for systematic validation process and continuous training of the infection control preventionists to maintain the accuracy, transparency, safe and comparability of surveillance data. The primary goal of health care-associated infections (HAI) surveillance is to identify and measure the progress towards achieving the lowest number of infections. Assessing the accuracy of reporting data using independent validation is critical to this goal. In 2018, with a perspective of strengthening the patient's quality and safety strategies, one group of 21 general private hospitals in Brazil were updated the system of reporting data of HAIs including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (PAV). These data began to be manage by a corporate infection control team. Aim: to test the accuracy of HAI rate, notified by a group of private hospitals in Brazil. Based on NHSN diagnostic criteria HAIs, all infections notified in 21 hospitals from five different states in Brazil was validate by four Infection Control Preventionists (corporative team). The validation process included a systematic retrospective chart review associated with the analysis of positive cultures over a period of five months (August to December 2018). 1357 cultures was evaluate of which 1314 (97%) met the NHSN definition for HAI. The HAI compliance rate separated by topography was: CLABSI 96%; CAUTI: 86% and PAV: 96%. Components of the case definition that were a source of misinterpretation included the following: CLABSI – misinterpretation of NHSN criteria between primary and secondary bacteremia, and differentiation regarding laboratory-confirmed bloodstream criteria 1 (recognized pathogen) and criteria 2 (skin contaminant); PAV - pneumonia cases notified only by clinical and non-epidemiological definition; CAUTI – reports of asymptomatic bacteriuria. The data of the hospitals studied are generally reliable. However, this study shows the need for systematic validation process and continuous training of the infection control preventionists to maintain the accuracy, transparency, safe and comparability of surveillance data.

Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape

BackgroundThe fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix.AimThe study aimed to determine the factors that influence patient falls.SettingA private hospital group in the Cape Metropole of the Western Cape.MethodsA quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS).ResultsIntrinsic factors contributing to patient falls includedthe patient’s age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment.ConclusionThe lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.

Factors influencing motivation of nurse leaders in a private hospital group in Gauteng, South Africa: A quantitative study.

BackgroundNurse leadership is about aligning employees to a vision. This happens with buy-in, motivation and communication. When conducive environments are created by organisations, the motivation of nurse leaders will be enhanced, which will have a positive outcome on the organisation. Highly motivated nurse leaders accomplish more and are more productive. Nurse leadership is an essential source of support, mentorship and role modelling. These attributes tend to be more evident when nurse leaders are motivated.ObjectivesThe objective of this study was to determine the factors that influence the motivation of nurse leaders.MethodA quantitative, descriptive design and stratified sampling was used. Participants comprised unit managers (n = 49) from five hospitals in a private hospital group in South Africa. A self-administered questionnaire, namely, the Multidimensional Work Motivation Scale, was used to collect the data. Data were analysed using the IBM SPSS 22.0 program.ResultsThe results indicated that the nurse leaders in this study were intrinsically motivated. Their motivation was influenced by support, relatedness, autonomy and competence. No relationships were found between motivation and age, years in a management position, gender, qualifications and staff-reporting structure.ConclusionBy implication, to understand what motivates nurse leaders and to keep them motivated, recommendations were proposed to nursing and human resources management. It is expected that the implementation of the recommendations will have a positive influence on patient outcomes, organisational success and the motivation and satisfaction of nurse leaders.

Patient Expectations and Satisfaction in Health Tourism Example of a Private Hospital Group

The aim of this study to determine the satisfaction level of the patients coming for health tourism in accordance with the received treatment services and the factors affecting their satisfaction. The study was performed in a private hospital group providing health service in more than one location in Istanbul. The data were collected through a survey. The survey was made between April-May 2018. The study included a total of 115 patients (both inpatient and outpatients). The satisfaction level for the services rendered was found out to be high both generally and sub-dimensionally. It was also found out that the satisfaction level was not statistically different at hospital and doctor sub-dimensions while it was statistically different at accessibility and nursing care sub-dimensions in accordance with the origin countries of the participant. It was stated out that the satisfaction of the participants whose medical expenses were covered by private insurances was higher than the others. It has been concluded from the study that increasing the awareness of health tourism in a sustainable way is only possible by determining the expectations of the patients correctly and providing satisfaction through the realization of these expectations.

Carbapenemase-producing Enterobacteriaceae colonisation in adult inpatients: A point prevalence study.

BackgroundInfections caused by carbapenemase-producing Enterobacteriaceae (CPE) have been increasing worldwide in recent years, but data regarding the prevalence and clinical significance of CPE colonisation in South Africa is not well documented. Local private hospital groups have implemented routine screening programmes for selected high-risk patients as endorsed by the South African Society for Clinical Microbiology. This practice is not routinely performed in the public sector.MethodsA point prevalence study was performed at Tygerberg Hospital (TBH) by screening patients of all the adult inpatient wards to investigate the current prevalence of CPE colonisation. Common risk factors associated with CPE colonisation were also investigated.ResultsFrom a total of 439 patient samples collected, only one patient was colonised with a Klebsiella pneumoniae organism harbouring blaNDM-1. The identified patient had none of the common risk factors associated with CPE colonisation.ConclusionBased on these findings, screening for CPE colonisation in adults on admission to TBH is currently not recommended.

Personality traits, illness behaviors, and psychiatric comorbidity in individuals with psychogenic nonepileptic seizures (PNES), epilepsy, and other nonepileptic seizures (oNES): Differentiating between the conditions

ObjectivesThe study aimed to investigate if South African individuals with psychogenic nonepileptic seizures (PNES) differ from individuals with epileptic seizures (ES) and other nonepileptic seizures (oNES) in terms of demographic and seizure characteristics, personality traits, illness behaviors, and depression, anxiety, and posttraumatic stress disorder (PTSD) comorbidity in statistically significant ways; and if so, to test if these differences can be utilized in raising suspicion of PNES as the differential diagnosis to epilepsy and oNES in practice. MethodsData were analyzed from 29 adults with seizure complaints recruited using convenience sampling from a private and a government hospital with video-electroencephalography (vEEG) technology. A quantitative double-blind convenient sampling comparative design was used. A demographic and seizure questionnaire, the NEO Five Factor Inventory-3 (NEO-FFI-3), an abbreviated version of Illness Behavior Questionnaire (IBQ), and the Beck Anxiety Inventory — Primary Care (BAI-PC) were administered. Cronbach's alphas, analysis of variance (ANOVA), cross-tabulation, Fisher exact test, and receiver operating characteristic (ROC) analyses were performed on the dataset. ResultsThe total sample consisted of 29 participants, of which 5 had PNES (17%), 21 ES (73%), and 3 oNES (10%). The final sample was comprised of 24 participants from the private hospital and 5 from the government hospital. The group with PNES was found to be significantly more male, to experience significantly more monthly seizures, and chronic pain when comparing the PNES with the ES group, and the PNES with the combined ES and oNES group in both private only sample, as well as the private and government hospital combined sample. Patients with PNES also had a higher level of education compared with the group with ES in the combined private and government hospital sample, something that was not evident in the private hospital only sample. No significant differences between groups were found in either sample in terms of age, population group, language, age at first seizure, and the NEO-FFI-3 subscales. All three groups scored above the cutoff point of 5 exhibiting depression, anxiety, and PTSD symptoms on the BAI-PC in both samples. However, the group with PNES tended to score significantly higher than the group with ES and the combined ES and oNES group in the private hospital sample. A cutoff point of 12 on the BAI-PC was found to predict PNES in this seizure population with 80% sensitivity and 89% specificity. However, once the analysis was repeated on the combined private and government hospital sample, significance in BAI-PC scores between groups was lost. All scales showed good reliability in our study, with the exception of the “Openness to Experience” subscale of the NEO-FFI-3 once reliability analysis was carried out on the combined private and government hospital group. ConclusionsThis study provides an important stepping stone in the understanding of demographic and seizure factors, personality domains, abnormal illness behaviors, and psychiatric comorbidity in the South African population with PNES. The study also reported on a cutoff score of 12 on the BAI-PC predicting PNES with 80% sensitivity and 89% specificity in a private hospital sample.

Editorial introductions

Editorial introductions