1,720,959 research outputs found
The prevalence of substance use in anaesthesia practitioners in South Africa
Full text linkIntroduction: Substance abuse has twice the mortality in United States anaesthesia- than non-anaesthesia residents. Since no data exist, the primary objective of this cross-sectional study was to establish the prevalence of substance use in South African anaesthesia practitioners. Secondary objectives were to compare the prevalence in male and female practitioners, and in private- and state practice anaesthetists. Years of experience and level of training were explored as possible risk factors for hazardous or harmful use. Method: Participants completed a self-administered, validated WHO questionnaire, run for ten days surrounding the 2018 South African Society of Anaesthesiologists (SASA) congress. All doctors practicing anaesthesia in South Africa were eligible. Recruitment was via an email link sent to all SASA members, as well as a web-based link at the congress. Results: A total of 1961 SASA members and 113 non-members (anaesthesiologists, registrars and non-specialists) were invited to participate (total 2074). There were 434 responses (response rate 20.9%, margin of error 4.18%); 364 were suitable for analysis. The most commonly lifetime-used substances were alcohol (92.8%), tobacco (42.3%), cannabis (34.7%), and sedatives (34.4%). Questionnaire scores defined low-, medium- and high-risk categories according to substance use during the previous 3 months. Sedative (12.6%) and alcohol (12.1%) users were deemed to be at moderate risk. The prevalence of opioid use was 1.9% (n=7). Prevalence of substance use was similar in male and female practitioners, as well as in those working in private practice or in state hospitals. Conclusion: The prevalence of current use of alcohol and sedatives is of major concern. A significant proportion of respondents were assessed to be at moderate risk of hazardous or harmful substance use. Gender and practice setting have little impact on substance use. Wellness efforts should be aimed at all anaesthesia practitioners in South Africa
Anaesthesia Preoperative Clinic (APOC) Audit
No full textBackground: Preoperative assessment clinics have been employed in many institutions to manage perioperative risks1. These clinics provide an opportunity to stratify patients on the basis of risk prior to surgery, to make timely multidisciplinary referrals where appropriate, and to prescribe medical therapies according to the current best evidence resulting, in fewer last-minute cancellations for medical reasons2 and a shorter inpatient pre-operative stay3. The Anaesthetic Pre-Operative Clinic (APOC-GSH) was introduced to Groote Schuur Hospital in 2009 with the aim of assessing and optimising high risk patients undergoing intermediate or high risk surgery. The vision of the clinic is to decrease perioperative morbidity and mortality, rationally and costconsciously investigate patients, as well as to reduce theatre cancellations of inappropriately assessed and managed patients. The clinic, together with relevant role players, attempts to risk stratify patients in making an informed decision whether the intended perioperative risks are acceptable. Patients referred to the clinic fall into two categories. Either the surgical date has been scheduled and patients are referred to APOC-GSH for optimization, or the referral is for assessment of suitability to undergo an anaesthetic and thus the treatment modality hinges on the fitness for surgery. Objective The intention of the audit is to create a database of the patients seen at APOC-GSH during 2014. Primary objectives are: 1 Referral pattern: - What proportion of patients are referred for improvement of medical condition? - What proportion of patients are referred for an assessment of operability? 2 What interventions were recommended? - What was the influence of interventions on operability and timing of surgery? - Does the clinic improve theatre efficiency by reducing cancellations of patients who required further interdisciplinary discussion and investigations? Methods: Data collection will be based on the review of APOC-GSH clerking notes and hospital patient records. The following information will be collected and entered into an Excel spread sheet: the surgical discipline referring the patient, the proposed surgery, patient co-morbidities, the lead-time from the first APOC-GSH assessment to surgery, number of visits to APOC-GSH by each patient, the investigations and additional interventions instituted at APOC-GSH. We shall also calculate the proportion of patients that would have likely been cancelled had they not attended APOC-GSH but rather been assessed by an anaesthetist the day before surgery. The record of the APOC-GSH consultation will be documented on a clerking sheet established for use within the clinic (Addendum A). The original form will be included in the patients' file and a duplicate will be stored within the access controlled Department Of Anaesthesia offices at GSH. The duplicate records will be used to obtain the information for the audit. Ethical approval will be sought from the UCT Human Research Ethics Committee for the establishment of the database and retrospective review of the APOC-GSH records on the understanding that patient records would be kept confidential and that the data obtained would be stored in a password protected spreadsheet. Access to the spreadsheet will be limited to the investigators involved and no identifiable patient details will be included. Patients will be counselled as to the nature of the study and will be expected to submit signed consent forms allowing their records to be reviewed. Patients will be informed that they will not be disadvantaged by refusal to sign the consent form and that the appropriate standard of care will still be applied. No remuneration will be provided for partaking either. Consent will be documented on the consent form specifically designed for use in the APOC-GSH. (Addendum B) Statistical analysis will be performed using an Excel® spreadsheet. Means, medians, rates and percentages will be used to describe the discrete categorical data. Output and future work The audit will provide an objective assessment of the population profile referred to APOC-GSH. It may guide future implementation of APOC-GSH protocol changes and assist with resource allocation depending on the surgical discipline requirements. Patient and surgeon satisfaction ratings may be embarked at a later stage juxtaposed against an adequate assessment in a cost and time conscious manner
An audit of the prevalence of abnormal fasting blood glucose levels in patients presenting for elective surgery at a selection of Western Cape government hospitals
Full text linkBackground. Diabetes mellitus (DM) is a common condition. The high burden of undiagnosed DM and lack of large population studies make accurate prevalence estimations difficult, especially in the surgical environment. Furthermore, poorly controlled DM is associated with an increased risk of perioperative complications and mortality. Objectives. The primary objective was to establish the prevalence of DM in elective adult non-cardiac, non-obstetric surgical patients in Western Cape hospitals. The secondary objectives were to assess the glycaemic control and compliance with treatment of known diabetics. Methods. This was a five-day, multicentre, prospective observational study performed at six government-funded hospitals in the Western Cape. Screening for DM was done using fingerprick capillary blood glucose (CBG) testing. Patients found to have a CBG of ≥ 6.5 mmol/L had an HbA1c level done. DM was diagnosed based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) diagnostic criteria. Patients known with DM had an HbA1c performed and Morisky Medication Adherence Scale (MMAS-4) questionnaires completed, to assess glycaemic control and compliance with treatment. Results. Of the 379 participants, 61 were known diabetics (16.15%; 95% CI 12.4-19.8%). After exclusion of eight patients with incomplete results, a new diagnosis of DM was made in five out of 310 patients (1.6%; 95% CI 0.2-3.0%). Overall prevalence of DM was 17.8% (66/371; 95% CI 13.9-21.7%). HbA1c results were available in 57 (93.4%) of the 61 known diabetics. Of these 27 (47.4%; 95% CI 34.4-60.3%) had an HbA1c level≥8.5% and 14 (24.6%; 95% CI 13.4 - 35.8%) had an HbA1c ≤7%. Based on positive responses to two or more questions on their MMAS-4 questionnaires, 12 out of 60 participants (20%) were deemed non-compliant. Conclusion. There is a low rate of undiagnosed DM in our elective surgical population; however there is a large proportion of poorly controlled DM. Since poorly controlled DM is known to increase postoperative complications, this likely increases the burden of perioperative care. Resources should be focused on improvement of long-term glycaemic control in patients presenting for elective surgery
A study of the prevalence of preoperative anaemia and iron deficiency in adult elective surgical patients in hospitals in the western cape province, South Africa. “A multicentre prospective observational study of the prevalence of preoperative anaemia and iron deficiency in adult elective surgical patients in hospitals in western cape province, South Africa.”
No full textBackground. Preoperative anaemia has been shown to be an independent risk factor for postoperative morbidity and mortality. Iron deficiency is the leading cause of anaemia globally. There are limited data describing the burden of perioperative anaemia and the relative contribution of iron deficiency in South Africa (SA). Objectives. To determine the prevalence and severity of preoperative anaemia in adults presenting for elective surgery in Western Cape Province, SA, and to investigate the contribution of iron deficiency as a cause of the anaemia. For this purpose, an investigative protocol from a recent consensus statement on the management of perioperative anaemia was applied. Methods. We performed a prospective, observational study in adult patients presenting for elective non-cardiac, non-obstetric surgery over a 5-day period at six Western Cape government-funded hospitals. The World Health Organization patient classification was applied, and patients with anaemia were investigated for iron deficiency. Results. The prevalence of preoperative anaemia was 28% (105/375; 95% confidence interval (CI) 23.5 - 32.5); 55/105 patients (52%) had moderate and 11/105 (11%) severe anaemia. Iron deficiency was the cause of anaemia in 37% (32/87; 95% CI 26.6 - 46.9), but only 9% of irondeficient patients received iron supplementation prior to surgery. Conclusions. Preoperative anaemia was common in this study, and more than half of the affected patients had moderate to severe anaemia. Iron deficiency was responsible for almost 40% of cases. Iron supplementation was under-utilised in the preoperative period as a means of increasing haemoglobin. The introduction of system-wide policies would empower perioperative physicians to mitigate the risk associated with preoperative anaemia in the Western Cape
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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