South African Patient Population Research Articles

Use of vital signs in predicting surgical intervention in a South African population: A cross-sectional study.

While vital signs are widely obtained for trauma patients around the world, the association of these signs with surgical intervention has yet to be defined. Early detection of trauma patients requiring surgery is essential to timely intervention and reduction of morbidity and mortality. The aim of this study was to determine the association of vital signs with surgical intervention in a South African patient population. This retrospective cohort included 7857 trauma patients admitted at Grey's Hospital in Pietermaritzburg, South Africa over a five-year period December 2012-April 2018. Exclusion criteria included missing key data points. Variables for analysis included sex, mechanism of injury, admission Glasgow Coma Scale (GCS), systolic blood pressure, diastolic blood pressure, temperature, heart rate, and respiratory rate. Surgical intervention was defined by the need for treatment requiring time in the operating room. Data were analyzed using a univariate and multivariate logistic regression to determine an association between admission vital signs and surgical intervention and was compared to the association of the Revised Trauma Score to surgical intervention. Of the 8722 trauma patient records available, exclusion of patients with incomplete data resulted in 7857 patient records available for analysis. Two thousand two hundred and ninety-six (29.2%) patients required surgical intervention in the operating room. Multivariate analysis revealed that male sex [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.48], stab wound (OR 3.42, CI 2.99-3.09), gunshot wound (OR 4.27, CI 3.58-5.09), systolic hypotension (OR 1.81, CI 1.32-2.48), hypothermia (OR 1.77, CI 1.34-2.34), tachycardia (OR 1.84, CI 1.61-2.10), and tachypnea (OR 1.26, CI 1.08-1.45) were associated with an increased likelihood of surgical intervention. In this cohort of patients, the need for surgical intervention was best predicted by penetrating mechanisms of injury, tachycardia, and systolic hypotension. These data show that rapid and focused patient assessments should be used to triage patients for emergency surgery to avoid delays.

A retrospective clinico-pathologic analysis of cemento-osseous dysplasia in a South African patient population.

Cemento-osseous dysplasia (COD) is a fibro-osseous jaw bone lesion. The affected bone in COD progressively becomes sclerotic, poorly vascularized and susceptible to secondary osteomyelitis. To provide a clinico-pathologic appraisal of COD in a South African patient population. Archived records of 133 patients diagnosed with COD were reviewed for patient demographics, COD location, COD type, osteomyelitis or simple bone cyst secondary to COD. The mean age was 53.4 ± 13.5 years with a 94.7% female predilection. COD mainly affected the mandible (57.1%), followed by involvement of both jaws (38.3%) and maxilla (4.5%). Florid COD was the most prevalent (69.9%), followed by focal COD (18%) and periapical COD (12%). Florid COD showed a clear trend of increasing with age, peaking in the sixth decade and decreasing thereafter. Osteomyelitis and simple bone cyst presented as complications of COD in 74.4% and 5.3% of cases respectively, while 21.8% of all cases of jaw osteomyelitis during the study period were secondary to COD. A higher frequency of jaw osteomyelitis secondary to COD was found compared to previous studies. No significant association was shown between any of the COD types and secondary osteomyelitis.

A pilot study: Use of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale in a South African patient population.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder which typically presents in childhood. This diagnosis may often be overlooked in adulthood, particularly in psychiatric populations. The Adult ADHD Self-Report Scale (ASRS) is an internationally used and reliable screener; however, studies investigating its use in African populations are limited.AimTo investigate the application of the ASRS in a South African setting.SettingA patient population in Port Elizabeth, South Africa, was identified as representing a developing or low- and middle-income country population.MethodsA convenience sample of acutely presenting psychiatric participants admitted for stabilisation was used. Fieldworkers administered the ASRS; collected information relating to demographics, differential diagnoses, substance use disorder (SUD) presence and substance consumption; and prescribed medication relating to current or historical treatment of ADHD.ResultsThe study sample included 30 participants, with black people representing the majority of participants. Adult ADHD Self-Report Scale completion revealed the rate of ADHD within the study population to be 43.3%, a contrast to the initially presumed prevalence of 6.7% which was based on reported methylphenidate therapy. A difference in SUD prevalence was identified between subjects screening positively and negatively for ADHD with a greater tendency towards SUDs seen for ASRS-positive individuals. Significant differences were identified in relation to cannabis- and polysubstance use for ASRS-positive individuals.ConclusionDespite limitations related to the sample used and challenges in ASRS administration, investigation findings support recommendations for ADHD screening inclusion in acute inpatient settings in South Africa and ASRS translation into indigenous African languages.

Tobacco use and oral sex practice among dental clinic attendees.

Tobacco use and oral sex (OS) are important risk factors for oral and oropharyngeal Human papillomavirus (HPV) infection. Little is known about the prevalence of OS practice in South Africa. This study aimed to determine the prevalence of OS practice and tobacco use in a South African patient population. This cross-sectional study used a structured questionnaire to collect socio-demographic characteristics, tobacco use, betel nut use and OS practice data from consenting adults (≥18 years; n = 850). Oral sex practices were recorded for patients 18–45 years-old (n = 514). Data analysis included chi-square and multiple logistic regression analyses. Of the study population, 55.2% (n = 468) were female, 88% (n = 748) self-identified as black Africans and 45.1% (n = 383) were unemployed. Furthermore, 19.7% (n = 167), 6.4% (n = 54) and 2.1% (n = 18) were current smokers, snuff users and betel nut users, respectively. Out of the 514 who answered the questionnaire in relation to OS, 22.8% (n = 115) reported to practice it. Oral sex practice in the age group 18–45 years was most common among the self-identified white participants (41.9%); and among tobacco users than among non-tobacco users (30.9% vs. 20.5%; p = 0.022). A multivariable-adjusted regression model showed that white South Africans were more likely to use tobacco than black Africans (OR = 5.25; 95% CI = 2.21–12.47). The practice of OS was more likely among those 18–35 years-old (OR = 1.67; 95% CI = 1.01–2.74), but had no significant association with tobacco use (OR = 1.06; 95% CI = 0.62–1.83). The observed age and ethnic differences in both risk behaviours suggest a need for targeted population intervention in order to reduce the risk for oral HPV infection.

Differences in erythrocyte sedimentation rates using a modified Westergren method and an alternate method.

Worldwide laboratories have adopted the use of modified or alternate methods for measurement of the erythrocyte sedimentation rate (ESR). The iSED from Alcor Scientific is a novel, alternate ESR method based on photometric aggregometry which offers improved operator safety and reduced analysis time. This study evaluated the diagnostic utility of the iSED in a South African patient population with a range of inflammatory disorders. We compared the iSED with the predicate modified Westergren method (StaRRsed, Mechatronics, Zwaag, the Netherlands) measured at 60minutes. Analysis was performed on K2 EDTA samples at three ESR measurement ranges (<20, 20-80 and >80mm/h) in 120 pediatric and adult inpatients and outpatients over a 2-week period. Precision, stability, and carryover were performed in accordance with the revised International Council for Standardisation in Haematology guidelines. The iSED demonstrated acceptable imprecision with minimal carryover (2.86%). The correlation coefficients at the 3 ESR measurement ranges were r=0.58, r=0.71, and r=0.56, respectively. The y-intercepts were -10.74 (CI -29.17 to 7.69), -5.95 (CI -18.60 to 6.69) and 246.05 (CI 591.42-99.31). This indicated a difference of a constant nature with an overall mean difference of 7.99mm/h (CI 5.87-10.13) (P<0.001). iSED ESR measurements were stable up to 24hours when stored at room temperature or at 4-8°C. This study demonstrated differences in ESR results, predominantly at extremes of the analytical range, using an alternate method. Careful consideration and performance monitoring of these novel methods are advised.

Prescribing patterns for Parkinson’s disease in a South African patient population

Article history: Received on: 11/12/2013 Accepted on: 15/01/2014 Available online: 30/03/2014 The primary aim of the study was to analyse the treatment of Parkinson’s disease in a defined patient population in South Africa. A cross-sectional, retrospective drug utilization study was conducted on prescription data of a national community pharmacy group for 2010. A total of 25 523 products were prescribed to 5 168 patients. Most patients (59.17%) were females. The average age of patients was 69.57±10.37 years. Levodopa-containing products constituted 46.50% of prescribing frequency. The highest sales value was attributed to a generic levodopa/carbidopa 100/25mg preparation, with the second being the innovator product of the same strength. Dopamine agonists (pramipexole and ropinirole) constituted 39.80% of prescribing frequency, followed by anticholinergic agents (9.20%), the MAO-B inhibitor selegiline (2.12%) and amantadine (1.80%). The cost of levodopa products in combination with a dopa decarboxylase inhibitor was 45.00% of the total expenditure on antiparkinsonian medication. Levodopa remained the gold standard for the treatment of Parkinson’s disease. Further investigations need to focus on dosages, side effects, compliance and continuity of medication.

English

The primary aim of this study was to determine the prescribing pattern of antipsychotic drugs to patients with dementia in a South African patient population.&nbsp; A retrospective, cross-sectional drug utilisation study was conducted on 2010 prescription data of a national community pharmacy group.&nbsp; A total of 1231 patients were prescribed medication for dementia.&nbsp; The average age of patients was 75.10 (standard deviation (SD)=10.27) years, with 56.13% of female patients. A total of 5264 anti-dementia products were prescribed at an average cost of R584.06 per product. Donepezil accounted for 45.84% of prescriptions, followed by memantine (36.51%). Differences were observed between females and males with respect to the prescribing frequency of the different active ingredients (c2=48.491; d.f.=3; p&lt;0.0001). Patients received on average 4.28 (SD=3.77) anti-dementia products over the year.&nbsp; Most patients (94.31%) received only one anti-dementia active ingredient during the year. Nearly a quarter of patients (23.23%) received one or more antipsychotic drugs despite &ldquo;black box&rdquo; warnings. &nbsp;Slightly more females were prescribed antipsychotic medication, with risperidone and quetiapine the most often prescribed antipsychotics. Older generation antipsychotics, such as haloperidol, were also prescribed. Despite warnings by health authorities, nearly a quarter of patients were prescribed antipsychotics. More comprehensive studies on antipsychotic use in dementia are needed to determine whether these drugs are used rationally and to ensure that the health of patients with dementia is not placed at risk. Key words: Alzheimer&rsquo;s disease, dementia, antipsychotics, prescribing patterns, drug utilisation study, risperidone.

Prescribing patterns of methylphenidate in a South African patient population who are members of a private medical aid

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An investigation into the prescribing patterns of selective serotonin re-uptake inhibitors in South Africa.

The primary aim of the study was to investigate the prescribing patterns of selective serotonin re-uptake inhibitors (SSRIs) used on a chronic basis in a defined South African patient population, and to calculate the average prescribed daily doses (PDDs) of selected SSRIs. Prescription data for 2117 patients from various medical schemes who were using antidepressant drugs on a chronic basis were analysed retrospectively. More than 70% of all the patients using antidepressants were females. The tricyclic antidepressants (TCAs) and the SSRIs accounted for approximately 75% of all the antidepressants prescribed. The average age of the patients using SSRIs was 48.1 years (SD = 13.4 years). Fluoxetine was the most frequently prescribed SSRI, accounting for 63.3% of all SSRI prescriptions and 21.9% of all antidepressant prescriptions. The average PDDs of citalopram (23.9 mg), fluoxetine (21.7 mg) and paroxetine (21.1 mg) were slightly higher than their defined daily doses (20 mg for all three drugs). The average PDD of fluvoxamine (93.5 mg) was lower than the DDD (150 mg), but was still within an acceptable dose range. It was concluded that fluoxetine was clearly the drug of choice in treating chronic depression in this patient sample, and that the PDDs used in the patient population studied were in agreement with local and internationally acceptable dosage ranges.