South African Medical Journal (SAMJ)
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Evaluation of wastage of commonly used anaesthetic agents in the operating theatres of a South African teaching hospital
Get PDFBackground. Anaesthetic drug wastage negatively impacts the already constrained economy in developing countries such as South Africa (SA). However, safe anaesthetic drug administration during both elective and emergency surgeries can be achieved without increasing wastage or costs. Drugs frequently wasted include those required in emergencies. Cost-reduction strategies, particularly in drug wastage, represent a potential area for short-term savings in hospital drug budgets. Increasing clinician awareness of drug wastage can help modify practices, leading to reduced waste while maintaining high-quality patient care.
Objective. To evaluate wastage of commonly administered anaesthetic drugs, and to evaluate preventable and routine drug wastage and its cost.
Methods. A prospective observational study was conducted in the operating theatre of Chris Hani Baragwanath Academic Hospital, a tertiary hospital in SA. Prospective data were collected for all patients who presented for elective and emergency surgical procedures at this institution over a 2-week period. Drug preparation and administration were determined by the treating anaesthesiologist. The amount of remaining drug in syringes and opened ampoules was considered as wasted. Routine drug wastage was defined as the remaining drug after the required dose was administered, while preventable drug wastage referred to drugs drawn but not administered to the patient.
Results. Data were collected from 373 participants, of whom 58% were undergoing elective surgery. The average drug wastage was 29.7%, comprising 21.3% routine wastage and 8.4% preventable wastage, with an effect size of 0.47 (p<0.001). Propofol accounted for the highest frequency of routine drug wastage, while preventable wastage was predominantly attributed to adrenaline, atropine and suxamethonium (emergency pharmacological agents). The average cost of routine wastage was ZAR3.85, significantly higher than the ZAR1.32 for preventable drug wastage (p<0.001). Multivariate regression analysis revealed a significant association between paediatric surgical cases and increased anaesthetic drug wastage (p=0.004).
Conclusion. The cost and wastage of anaesthetic drugs pose significant challenges in healthcare institutions, particularly in developing countries with limited resources. Implementing cost-effective strategies, such as using smaller ampoules and prefilled syringes, has been demonstrated to reduce drug wastage without compromising patient care
Using the 99DOTS (directly observed treatment, short course) application for improved adherence to tuberculosis treatment in Namibia: A mixed-methods study
Get PDFBackground. In Namibia, community-based directly observed tuberculosis (TB) treatment (C-DOT) has been effective for individuals living in settled villages, but it is problematic for mobile indigenous people who survive through hunting and gathering and have among the highest TB and multidrug-resistant TB rates and lowest adherence to TB treatment globally.
Objectives. The 99DOTS (directly observed treatment, short course) programme was piloted in the Tsumkwe Healthcare Centre and the 25 villages in the catchment area from quarter 2, 2019 to quarter 1, 2020. Programme staff facilitated and monitored TB treatment adherence.
Methods. Twenty patients and two healthcare workers who managed the patients were interviewed on treatment completion using a semi- structured interview process.
Results. Respondents were of low socioeconomic status; many were not schooled and not employed, and few had a monthly household income >NAD100 (USD5.50). According to the programme server reports, only six of the respondents did not miss any doses of their TB treatment, although few doses were missed proportionally. Most respondents reported a supportive family structure and health system, with treatment support given by families and regular follow-up by health workers. Positive feedback was received about use of the 99DOTS application; respondents found the application easy to use and did not mind using it in front of other people, in and out of their homes.
Conclusion. 99DOTS was a feasible, innovative and accessible treatment adherence component integrated directly into the existing C-DOT approach. National TB programmes in similar high-burden settings could consider this approach to improve adherence
Is it time for South Africa to resuscitate the national dialogue on the right to end one’s own life?
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Venous thromboembolism prevention in South Africa: Bridging the gap between guidelines and practice
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Pregnant patients with severe headaches – don’t forget brain tumours!
Get PDFAlthough sometimes innocuous, headaches in pregnancy may be associated with serious, even life-threatening conditions, with diagnosis delayed due to nonspecific findings associated with normal pregnancy. Meningiomas are the most common primary tumours, have a strong female predisposition and are mostly benign. There is a paucity of information on the diagnosis and management of meningiomas during and after pregnancy. In this article, we describe two cases of meningioma with differing management, seen within a period of 6 months. In case one, iatrogenic preterm delivery of the baby at 33 weeks’ gestation was executed to facilitate vision-saving neurosurgery. In our second case, delivery was at early term, with time allowed for postpartum re-evaluation before definitive neurosurgery
Progress in advanced cellular and gene therapies in South Africa and barriers to patient access: A National Consortium paper on behalf of the BloodSA Cell and Gene Therapy working party
Get PDFThe fields of molecular and cellular medicine have, in recent years, witnessed a great deal of progress globally, particularly in understanding disease pathogenesis and through the development of advanced cellular therapy products and gene therapies. Despite the transformative potential of these new therapies, low- and middle-income countries face significant barriers to their access. Advanced cellular therapy legislation in South Africa (SA) has not kept up with this fast-advancing field, and requires a fast-tracked renewal. Furthermore, the prohibitive cost of commercial therapies, including chimeric antigen receptor (CAR) T-cell products, and the lack of infrastructure, manufacturing and research capacity, must be addressed to make equitable patient access an achievable goal in our setting. To this end, a national cell and gene therapy consortium, comprising clinicians, clinician-scientists, scientists, legal experts, postgraduate students and representatives from industry, the national blood service and the pharmaceutical industry, was initiated. The mandate of this group is to aid the progression of advanced cellular therapies in SA, and the purpose of this article is to outline the progress that has been made. We will highlight the gaps in each core field of practice within this space, and provide a proposal for making these therapies more accessible in SA.
Data privacy and protection in AI-driven healthcare
Get PDFThe concept of keeping health data private is constantly being tested, as what constitutes health data has grown significantly, now including massive amounts of personal information from a variety of sources, such as genomic data, radiological images, medical records, and non- health data converted into health data. These numerous sources of data, collectively termed ‘biomedical big data’ (BD), comprise a health data ecosystem that has altered the landscape of health research. BD, which is often referred to as the ‘new oil’, provides a natural blueprint for artificial intelligence (AI) to thrive and to generate and advance knowledge exponentially. However, while the need for data grows, data breaches are on the rise, specifically in the healthcare sector. The rise in local data breaches underscores the urgent need to translate paper into practice by strengthening systems and enforcing the ethico-legal framework governing the processing of data in SA, including ways in which to efficiently handle its misuse. This involves ensuring the adoption of ethically sound practices, adaptable infrastructure, and robust governance that is specific to the SA context
