South African Medical Journal (SAMJ)
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Response to letter regarding ‘Cyberattack on the National Health Laboratory Service of South Africa – implications, response and recommendations’
Get PDFOutcomes of emergency resuscitative thoracotomies in a trauma unit in Johannesburg, South Africa
No full textBackground. Emergency resuscitative thoracotomies (ERTs) are life-saving procedures for traumatic cardiac arrest or severe haemorrhage, but their outcomes remain variable and are influenced by several factors, including timing, mechanism of injury and the presence of initial signs of life. Studies on ERT outcomes predominantly originate from well-resourced settings, leaving a gap in understanding their effectiveness in resource-constrained environments.
Objective. To conduct a prospective audit of ERTs performed at a level 1 trauma unit over a 1-year period (1 April 2023 - 31 March 2024), assessing initial presentation characteristics, indications for ERT and subsequent outcomes in terms of survival and complications.
Methods. A prospective analysis of 19 consecutive patients who underwent ERT was performed. Data included demographics, mechanism of injury, initial physiological parameters, ERT indications, resuscitation times, blood product transfusions, complications and survival to discharge.
Results. The study comprised predominantly male patients (94.74%) with a wide age range (19 - 68 years). Penetrating trauma was the most common mechanism of injury (94.44%). An association was observed between shorter interval between fluid resuscitation time and commencement of ERT time and survival. Elevated lactate levels and acidosis were more frequent in non-survivors. A high mortality rate was noted (only one patient survived).
Conclusion. This study did not find statistically significant results, but recognising the importance of prompt and ongoing resuscitation in improving survival after ERT is consistent with existing literature. However, the small sample size significantly limits the ability to apply these findings to other cases. Larger studies are necessary to definitively establish the impact of factors such as resource limitations on ERT outcomes in under-resourced settings. The high mortality rate highlights the need for focused research into improving patient selection criteria, optimising ERT techniques and addressing resource constraints in developing countries
The usability of an electronic health record in a public healthcare facility in South Africa
No full textBackground. An electronic health record (EHR) is a record of patient health information generated by encounters in healthcare delivery settings, and it plays a crucial role in the digital evolution of healthcare. EHRs, such as ‘Patients Know Best’ (PKB), are commonly used in health systems of developed countries, but are lacking in developing countries. Challenges and opportunities surrounding EHRs in Africa have been identified, but limited literature exists on how these factors may impact the practical use of digital health technologies within South Africa (SA).
Objectives. To determine the usability of the PKB platform, as indicated by the patients and clinical staff registered on PKB at the Breast and Endocrine Surgery Clinic, Tygerberg Hospital (TBH). In addition, this study aimed to determine patients’ and clinical staff’s level of engagement with the PKB platform. Level of engagement was compared with a similar patient user group in the UK.
Methods. A prospective cohort study was conducted at the Breast and Endocrine Surgery Clinic, TBH. One hundred and fifty participants, including clinic patients and staff, were enrolled. Demographic information was collected at the time of recruitment, and a questionnaire measuring perceived PKB usability was administered electronically 6 weeks post enrolment. User engagement metrics were recorded during the study. Demographic and user engagement data from 49 patients using PKB in the UK were used for comparison purposes. Statistical analysis allowed for a description of the sample’s demographics, a comparison of engagement levels between groups, an assessment of PKB platform usability and the identification of factors associated with completing the questionnaire.
Results. During the study period, 42% of SA participants registered on PKB, 26% logged in and 20% completed the usability questionnaire, for which an adequate PKB usability score was determined. The 45 - 54-year age group engaged most, with a maximum range of 11 - 20 logins recorded. The PKB feature most frequently accessed was the message/consultation feature. By comparison, almost all (96%) UK participants completed registration and logged in. The 55 - 64-year age group engaged most, with a maximum range of over 120 logins recorded. Laboratory results were the most frequently accessed feature.
Conclusion. Implementing an EHR system such as PKB without necessary adaptations in the current SA public healthcare system environment is not feasible. Adaptations required include allowing patients access to the EHR system without an email address, integrating the EHR system with existing information technology infrastructure and streamlining hospital digital notes with EHR systems to enhance patient engagement and reduce healthcare worker burden
Beyond vasopressor support: VA-ECMO for refractory calcium channel blocker overdose
No full textCalcium channel blocker (CCB) overdose is a life-threatening toxicological emergency associated with vasoplegia and multiorgan failure.We report a case of a 15-year-old male who presented with polypharmacy ingestion and refractory shock despite high-dose insulin euglycemic therapy, calcium supplementation and vasopressor support. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)was initiated 48 hours after ingestion and 40 hours after intensive care unit (ICU) admission. The patient was decannulated after 72 hours on ECMO, and discharged home on day 7 of ICU admission. This case highlights the role of VA-ECMO as a rescue intervention in severeCCB toxicity where conventional therapies fail
Mob assault victim fatalities admitted at a forensic pathology laboratory in a South African rural province
No full textBackground. Community-based assault is a phenomenon carried out worldwide, which contributes to the rise in unnatural deaths due to violence. In South Africa (SA), this is often referred to as mob assault or vigilantism. There is a paucity of literature on the prevalence and epidemiology of this phenomenon in SA.
Objectives. To profile fatal mob assault victim cases admitted at the Polokwane Forensic Pathology Services Laboratory, Limpopo Province. For this to be achieved, the study determined the demographic characteristics of the victims, examined the circumstances of the incidents and noted whether or not victims were hospitalised prior to death.
Method. A quantitative, descriptive cross-sectional study was conducted using a sample of 141 community assault death victims that were selected using consecutive sampling of such victims admitted to Polokwane Forensic Pathology Services Laboratory over 5 years (2018 - 2022).
Results. The study revealed that black adult males residing in townships suffered fatal mob assault. All victims were black men, mostly South African, from the Polokwane subdistrict (75.9%), with a median age of 28 years, and only 33.3% were hospitalised before their death. Within the Polokwane subdistrict, the majority of cases (59.6%) were from the two largest townships (Seshego (31.9%) and Mankweng (27.7%)). A higher proportion of victims (39.7%) had lower levels of education and were mostly unemployed (76.6%). The main causes of death included multiple injuries, head injuries and severe soft-tissue injuries.
Conclusion. This study highlighted the complex dynamics of community assault and its impact on public health. The high incidence of multiple injuries and elevated fatality rates prior to hospital admission can be primarily attributed to the violent conduct of communities and mobs. These groups often engage in aggressive confrontations that escalate quickly, leading to severe injuries and fatalities. Addressing community assaults requires a multifaceted approach, including community engagement, conflict resolution programmes and preventive measures aimed at reducing the occurrence of mob assaults
Bridging education and service: The Walter Sisulu University Integrated Longitudinal Community Clerkship programme’s impact on healthcare
No full textEnabling participation in activities of daily living for people living with obesity
No full textRECOMMENDATIONS
1. We recommend that HCPs ask PLWO if they have concerns about managing self-care activities such as bathing, getting dressed, bowel and/or bladder management, skin and/or wound care, foot care (Level 3, Grade C).
2. We recommend that HCPs assess falls risk in PLWO, as this could interfere with their ability to participate in physical activity and their interest in doing so (Level 3, Grade C).
